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THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 

PRICK    Sl.OO    PER     YEAR 


Contributions  invited  from  the  Alumni  of  the  University 
Business  Address,  Baltimore,  M 


atered  at  the  Baltimore  Post:office 
as  Second  Class  Matte/.  , 


VOL.    V 


BALTIMORE,   MD.,   MARCH  15,   1909 


jrf-Vfl* 


No.  1 


LAENNEC. 

An  Address  delivered  before  the  Nu  Sigma  Xit 
Fraternity,  February  20,  1909, 

By  Samuel  C.  Chew,  M.  D.,  LL.  D., 

Professor  of  Medicine  in  the  University  of 

Maryland. 

Among  the  most  pleasant  recollections  of  my 
past  professional  life  is  the  thought  that  I  was 
one  of  the  first  to  extend  a  cordial  greeting  and 
welcome  to  our  friend  and  colleague,  then  a 
newly  arrived  stranger  here,  now  and  for  many 
years  past  a  most  cherished  member  of  our  own 
household,  in  whose  honor  we  are  gathered  to- 
gether tonight — Professor  William  H.  Welch. 
It  was  at  the  house  of  a  mutual  friend  who  was 
also,  if  I  mistake  not,  a  classmate  of  Dr.  Welch 
at  Yale  University ;  and  then  began  a  friendship 
and  a  regard  which  have  continually  grown  in 
my  feeling  towards  him  with  the  lapse  of  time — 
a  friendship  which  I  shall  always  account  a  priv- 
ilege and  a  pleasure,  a  regard  which  will  only  in- 
crease with  increasing  years. 

I  have  been  asked  to  respond  on  this  occasion 
to  the  sentiment  of  the  name  and  labors  of  Laen- 
nec,  and  it  is  not  difficult  to  find  a  connecting 
link  between  the  work  of  so  eminent  a  patholo- 
gist as  Professor  Welch  and  that  of  the  founder 
of  the  science  of  auscultatory  diagnosis.  For  it 
must  be  kept  in  mind  that  accurate  diagnosis  of 
affections  of  the  lungs  and  heart  rests  perhaps 
more  immediately  upon,  and  is  determined  by  a 
knowledge  of  pathological  changes  in  those  or- 
gans, it  is  attained  with  greater  precision  and 
greater  promptitude  with  the  possession  of  such 
knowledge,  than  is  the  case  with  many  other,  or, 
perhaps,  I  may  say,  any  other  organic  diseases 
of  equal  gravity.  The  special  value,  indeed,  of 
the  method  of  auscultatory  diagnosis  is  found 
in  the  certainty  of  the  conclusions  which  it 
reaches  in  difficult  and  complicated  cases,  so  that 
it  may  be  said  without  exaggeration  that  it  is  as 


powerful  a  solvent  of  previously  insoluble  prob- 
lems as  the  calculus  is  in  mathematics. 

It  seems  strange,  indeed,  that  in  Laennec's  own 
time  one  objection  urged  against  auscultation 
was  that  it  attempted  to  raise  medicine  to  the 
rank  of  an  exact  science  and  place  it  by  the  side 
of  mathematics  and  astronomy. 

And  this  also.  I  think,  may  be  said,  that  in  the 
entire  range  of  all  branches  of  knowledge  there  is 
not  a  more  remarkable  instance  of  profundity  of 
thought,  of  the  power  of  penetrating  to  the  deep 
and  hidden  unknown  and  bringing  it  into  the 
light,  than  is  afforded  by  that  science  of  auscul- 
tation which  sprang  almost  perfect  and  com- 
plete— and  there  is  the  wonder  of  it — from  the 
brain  of  one  man,  from  the  brilliant  genius  of 
Laennec.  And  this  claim  to  originality  in  behalf 
of  Laennec  may  surely  be  made  without  forget- 
fulness  of  the  fact  that  in  the  early  dawn  of 
scientific  medicine  Hippocrates  used  the  sense  of 
hearing  in  the  diagnosis  of  thoracic  dis- 
ease; nor  of  the  further  facts  that  many  cen- 
turies later  Auenbrugger  practiced  percussion ; 
and  that  still  later  Corvisart  made  use  of  this 
means  to  some  extent.  Hut  the  method  did  not 
in  the  hands  of  any  of  these  physicians  serve  the 
purpose  of  establishing  certainty  of  diagnosis. 
That  which  Laennec  accomplished  was  the  crea- 
tion of  a  science  which  converted  previously  un- 
heard, unheeded  and  confused  sounds  into  an 
articulate  language,  speaking  with  logical  pre- 
cision and  conveying  truth  with  the  certainty  of 
mathematical  demonstration.  It  was  said  by  the 
eminent  pathologist,  Rokitansky,  that  "had  Laen- 
nec done  nothing  else  for  medical  science,  his 
discovery  of  emphysema  and  of  the  causes  giving 
rise  to  it  would  have  been  sufficient  to  render  his 
name  immortal."  But,  important  as  this  contri- 
bution to  medical  knowledge  was,  it  was  a  small 
and  very  limited  part  of  Laennec's  great  achieve- 
ments. 

Just  ninety-four  years  ago,  in  February.  1815, 
Laennec  communicated  to  the  Sonde  de  I'Fcole 


THE   HOSPITAL  BULLETIN 


his  first  results  in  auscultatory  diagnosis.  On 
the  30th  of  April  following  he  submitted  another 
treatise  on  the  same  subject  to  the  same  body, 
and  on  May  14th — an  illustrious  day  in  the  his- 
tory of  medicine — he  made  his  first  essay  with 
the  stethoscope.  April  and  May,  1815 — memor- 
able months  for  far  different  reasons  of  a  most 
memorable  year.  Consider  the  contrast  between 
the  events  of  the  outside  world  at  this  time,  when 
the  embattled  armies  of  Europe  were  being  mar- 
shaled for  the  tremendous  struggle,  which  in  a 
few  weeks  found  its  close  in  the  carnage  of 
Waterloo,  and  on  the  other  hand  the  work  of  the 
quiet  student  going  on  at  the  same  time  within 
the  wards  of  the  Beaujon  and  Keeker  hos- 
pitals, earnest  in  his  labors,  constant  in  his  duties, 
devout,  as  we  are  told  he  was,  in  his  religious 
faith,  strict  in  his  adherence  to  the  Catholic 
Church  of  his  country,  and  bent  upon  the  acqui- 
sition of  knowledge  which  should  lessen  human 
suffering  and  save  multitudes  of  human  lives. 
And  yet,  outside  of  our  own  profession,  how  few 
there  are  who  have  known  even  the  name  of  that 
great  benefactor  of  humanity. 

"Of  two  such  lessons  why  forget 
The  nobler  and  the  better  one  ?' 

Consider  the  contrast.  May  it  not  be  likened 
to  the  difference  between  the  confusion,  turmoil 
and  strife  of  "the  corrupted  currents  of  this 
world"  and  those  blessed  ministrations  of  good 
which  may  engage  the  serene  and  beneficent  in- 
telligencies  beyond  the  veil  ? 

Throughout  the  whole  civilized  world 
there  are  few  persons  who  have  not  at 
some  time,  and  many  of  them  many  times,  re- 
ceived the  boon  of  health  or  the  boon  of  life 
from  knowledge  contributed  to  mankind  by  the 
untiring  labor,  the  devotion  to  duty  and  the 
splendid  genius  of  Rene  Theodore  Laennec. 

The  work  of  Laennec  placed  the  pathology  and 
diagnosis  of  thoracic  diseases  upon  a  basis  of 
certainty,  and  was  thus  of  vast  importance  in 
preparing  the  way  for  their  rational  treatment ; 
for  scientific  therapeutics  must  always  be  guided 
by  a  knowledge  of  the  nature  of  disease  and  the 
determination  of  its  exact  situation  and  stage. 

In  discussing  the  question  whether  direct  inoc- 
culation  can  cause  the  development  of  tubercu- 
lous disease,  Laennec  said  that  on  this  subject  he 
had  but  a  single  fact  to  adduce,  adding  that 
though  a  single   fact  may  prove  little,  it  ought 


to  be  stated.  The  fact  to  which  he  referred  was 
presented  in  his  own  case,  and  it  was  this,  that  in 
examining  some  tuberculous  vertebrae  he  slight- 
ly grazed  with  the  saw  the  forefinger  of  his  left 
hand,  with  the  result  that  a  small  tumor  was  by 
degrees  formed  in  the  place  containing  a  yellow 
body  precisely  resembling  a  crude  tubercule. 

This  infection  may  have  caused  the  pulmonary 
tuberculosis  of  which  he  ultimately  died,  a  vic- 
tim, it  may  be,  of  his  earnest  quest  of  knowledge 
and  a  victim,  too,  of  that  malady  upon  the  nature 
of  which  he  had  himself  shed  such  abundant 
light. 


REPORT  OF  A  CASE  OF  INTESTINAL 

OBSTRUCTION  COMPLICATING 

ACUTE  APPENDICITIS. 

By  C.  F.   Strosxidek,   '09, 
Senior  Medical  Student. 

Name,  Robt.  "Washington;  race,  black;  age, 
20  years ;  civil  status,  single ;  occupation,  la- 
borer; date  entered,  August  10,  1908;  date  dis- 
charged. September  5,  1908. 

Diagnosis. — Intestinal  obstruction  compli- 
cating acute  appendicitis  (high  post  coecal). 

Complaint. — Constipation  and  pains  in  abdo- 
men ;  family  history,  father  and  mother  living 
and  well ;  no  brothers  or  sisters  in  family. 
Family  history  negative  as  to  tuberculosis, 
rheumatism,  gout,  haemophilia  and  insanity. 

Past  History. — Born  naturally;  was  healthy 
as  a  child,  having  during  childhood  whooping- 
cough,  measles  and  chicken  pax,  but  negative 
as  to  sequelae.  Teething  normal ;  walked  at 
age  of  one  year;  always  healthy  until  present 
illness. 

Habits. — Smokes  moderately,  eats  heartily 
and  fairly  regularly.  Does  not  chew  tobacco. 
Drinks  beer  or  gin  occasionally.  Drinks  three 
cups  of  coffee  daily.    Keeps  late  hours  at  night. 

History  of  Present  Illness. — Was  taken  sick 
on  August  10,  1908  (Wednesday),  about  2.30 
P.  M.,  whilst  driving  a  cart,  with  nausea,  vom- 
iting, severe  abdominal  pains,  which  were  gen- 
eral, accompanied  by  a  diarrhoea,  the  stools 
being  greenish  in  color  and  at  first  copious  in 
amount. 

Each  attack  was  accompanied  with  severe 
headache.  Such  attacks  lasted  for  about  fifteen 
minutes,  gradually  subsiding,  until  the  pain 
and    other    symptoms    would    be    gone    for    a 


THE   HOSPITAL  BULLETIN 


period  of  about  fifteen  minutes.  About  six 
o'clock  his  bowel  movements  did  not  accom- 
pany the  attacks,  and  pain  began  to  radiate 
over  the  right  side  of  the  chest  from  the  region 
of  the  gall  bladder  to  a  point  under  the  right 
scapula  and  shoulder ;  also  with  shooting  pains 
radiating  down  the  back  and  terminating  in 
the  glans  penis. 

A  physician  was  called  in  and  diagnosed  the 
case  as  one  of  "cramp  colic,"  and  treated  the 
same  as  such.  Pain  was  relieved,  but  he  con- 
tinued to  be  nauseated  and  constipated.  On 
Saturday  evening  his  pains  returned  and  the 
abdomen  began  to  become  distended,  which 
gradually  grew  worse  until  Sunday  morning, 
August  14,  when  he  was  sent  to  the  hospital. 
Upon  arrival  he  was  found  to  be  suffering 
with  excruciating  pain,  and  was  very  restless, 
the  abdomen  being  greatly  swollen  and  of 
boardlike  hardness.  He  had  been  able  to  re- 
tain but  very  little  food  since  the  attack  began. 
His  temperature  registered  104°  F.,  pulse  140, 
respiration  40. 

Physical  examination  developed  the  fol- 
lowing: 

General  Condition. — The  patient  lay  on  his 
back,  with  rather  difficult  breathing,  being 
restless  and  anxious.  Was  well  nourished 
weighing  150  pounds. 

Skin. — Black,  tight,  with  plenty  of  sub-cuta- 
neous fat ;  no  eruptions ;  rather  hot  and  moist ; 
heavy  suit  of  hair;  nails  rather  blue. 

Digestion. — Teeth  in  excellent  condition, 
mucous  membrane  and  lips  of  mouth  appeared 
dry  and  rather  congested ;  tongue  was  covered 
with  thick  white  coat  and  protruded  without 
tremor;  swallowed  normally;  no  tracheal  tug; 
stomach  was  unable  to  retain  food  on  account 
of  nausea  and  vomiting,  which  vomit  contained 
bile. 

Abdomen. — Muscles  were  boardlike  in  rigid- 
ity; no  abdominal  movement  was  perceptible 
during  respiration,  as  the  muscles  were  fixed. 

Tenderness. — Maximum  point  was  on  right 
side  from  gall  bladder  area  to  McBurney's 
point.  No  enlargement  of  the  gall  bladder  or 
appendical  abscess  could  be  made  out  by  pal- 
pation, but  dulness  could  be  elicited  by  percus- 
sion on  the  right  side  to  the  right  of  the  rectus 
muscle ;  otherwise  the  belly  was  tympanitic. 

Vascular  System. — The  heart  sounds,  its 
size  and  position  were  normal.     Pulse  rate  140 


per  minute,  regular  in  force  and  rhythm,  good 
volume  and  compressible,  high  tension. 

Respiration.  —  Breathing  rapid  (40  per 
minute),  rather  shallow  and  expiration  pro- 
longed, owing  to  abdominal  muscle  fixation. 

Nervous  System. — Had  anxious  expression, 
severe  headache  and  appearance  of  suffering 
great  pain  ;  very  restless,  thirsty  and  begging 
for  relief;  special  senses  were  negative;  could 
not  test  motor  areas  for  faulty  gait  or  diseased 
joints  on  account  of  condition ;  tactile,  pain, 
heat  and  cold  and  muscular  senses  were  nor- 
mal ;  reflexes  normal ;  generative  organs  ap- 
peared to  be  normal. 

Microscopically. — Sputum  was  negative. 

Blood. — Leucocyte  count  was  12,000  per  C. 
M. ;  haemoglobin  80  per  cent. 

Tertian  malaria  parasites  were  present  in 
small  numbers. 

Urine. — Catheterized  specimen  of  500  c.  c. ; 
acid  in  reaction,  sp.  gr.  1032;  slight  ring  of  al- 
bumen in  Heller's  test;  sugar  negative;  Indi- 
can  was  present  in  excess. 

Cells. — Few  kidney  cells  and  bladder  cells 
present ;  few  hyaline  casts  and  a  small  amount 
of  mucus.    Highly  colored  by  indican. 

I  completed  history  at  12.30  P.  M.  and  gave 
the  above  mentioned  diagnosis.  Patient  was 
taken  to  operating  room  at  1  P.  M. 

Operation — Anaesthetic  Ether. — Anaesthet- 
ist. Dr.  J.  D.  Kerr;  surgeon,  Dr.  R.  B.  Seem; 
assistant,  the  writer.  Duration  of  operation, 
one  hour. 

A  vertical  incision  was  made  four  inches  in 
length  along  the  outer  margin  of  the  right 
rectus  muscle,  the  fascia  muscle  being  pushed 
in  towards  the  mid  line,  the  posterior  fascia 
and  peritoneum  were  picked  up,  respectively, 
and  cut,  the  latter  being  caught  by  forceps  and 
incision  completed.  Superficial  skin  and  fascia 
vessels  were  clamped  and  tied  and  deep  ab- 
dominal retractors  put  in  desired  location  and 
traction  made.  On  inspection  the  omentum 
was  found  to  be  tied  down  to  the  caecum  and 
ascending  colon,  and  the  small  intestines  were 
greatly  distended  with  gas.  Upon  walling  off 
the  intestines  with  a  Boston  pack  the  omentum 
was  released  at  the  highest  point,  and  a  pocket 
of  pus  was  discovered,  which  extended  from 
the  base  of  the  appendix  to  under  the  right 
margin  of  liver;  about  one  pint  of  pus  was 
mopped  from  this  pocket.    Appendix  was  four 


THE   HOSPITAL   BULLETIN 


and  one-half  inches  long,  being  located  post- 
caecally  (high)  and  tied  down  by  adhesions, 
and  ruptured  and  gangrenous  at  the  distal 
three  inches.  Adhesions  were  broken  up  and 
appendix  freed  with  great  difficulty.  It  was 
clamped,  tied  off,  a  pucker  string  put  around 
the  stump,  carbolic  acid  and  alcohol  used  on 
stump,  which  was  turned  into  caecum,  when 
the  drawstring  was  tied  and  a  row  of  sutures 
put  over  the  same,  drawing  peritoneum  to- 
gether over  it.  The  omentum  was  found  to 
be  thrombosed  to  the  extent  of  about  2^3 
inches,  which  was  tied  off  and  amputated. 

Intestinal  Obstruction. — At  a  point  three 
inches  from  the  ileocaecal  valve  a  small  band 
about  the  size  of  a  shoe  lace  was  found  to 
constrict  the  ileum,  causing  absolute  obstruc- 
tion of  the  intestine.  This  band  did  not  en- 
circle the  intestine  entirely,  but  extended 
across  it  from  side  to  side.  No  cause  could  be 
given  for  its  presence.  It  was  tied  off  with  fine 
silk  and  clipped  with  scissors,  thus  removing 
the  obstruction.  No  other  cause  of  obstruction 
could  be  located  by  a  further  examination  of 
the  intestinal  tract,  and  drainage  was  provided 
for  by  placing  a  long  cigarette  drain  in  the 
pelvic  cavity,  another  under  the  liver  and  a 
third  one  at  the  base  of  the  appendix. 

The  incision  was  then  closed  between  the 
upper  and  lower  drains,  the  peritoneum, 
fascias  and  skin,  respectively,  with  interrupted 
sutures  of  catgut  (20-day  chromized)  ;  wound 
was  dressed  with  gauze,  cotton  and  bandage. 

Patient  was  returned  to  ward  in  a  shocked 
condition.  Temperature,  103^;  pulse,  150; 
respiration.  36.  Pulse  was  weak  and  small  in 
volume  and  irregular  in  force  and  rhythm;  ex- 
tremities were  cold  and  clammy.  Patient's 
stomach  was  washed  out  with  warm  water. 
Hot  blankets  and  water  bottles  were  applied  to 
the  extremities  and  the  foot  of  the  bed  elevated 
until  the  shock  had  been  overcome. 

Hypodermodysis  of  800  c.  c.  normal  salt 
solution  was  given  in  the  axilla;  hypodermics 
of  strychnine  and  hot  brandy  at  four-hour  in- 
tervals. After  recovery  from  the  shock  the 
patient  was  put  in  a  sitting  position. 

After  Treatment. — No  food  was  given,  and 
<»nly  cracked  ice  by  mouth  for  first  24  hours. 
Nutriment  enemata  of  peptonized  milk  and 
warm  coffee  (with  whiskey,  zss)  q.  s.  ziv.,  t.  i. 
d.     Then  albumen   water  zii  q.  2  hrs.,  and  on 


third  or  fourth  day  milk  z  iv.  q.  four  hours.  On 
seventh  dav  soft-boiled  eggs,  milk  and  toast, 
soups;  on  twelfth  day  regular  house  diet. 

Drugs. — Strychnine,  gr.  1-30  q.  6  hours,  al- 
ternating with  nitroglycerine,  gr.  1-100,  qui- 
nine sol.  gr.  ii  ss,  q.  3  hours.  Nitroglycerine 
was  dropped  on  sixth  day.  Patient's  pulse, 
respiration  and  temperature  rapidly  improved 
until  normal  was  reached.  Each  nutriment 
enema  was  preceded  by  a  normal  salt  enema. 

Hypodermodysis  of  800  c.  c.  normal  salt  so- 
lution was  given  daily  for  three  days,  which 
seemed  to  do  great  good. 

Dressing. — Wound  was  dressed  daily  for 
eight  days,  then  every  other  day  until  he  was 
discharged.  On  third  day  deep  pelvic  drain 
was  removed ;  on  fifth  day  drain  under  liver 
was  removed  (discharge  having  ceased  from 
these  drains)  ;  on  sixth  day  drain  over  stump 
of  appendix  was  removed  and  shortened,  again 
on  eighth  day,  and  entirely  removed  on  twelfth 
day,  and  iodoform  gauze  used  in  its  stead.  At 
each  dressing  area  around  wound  was  thor- 
oughly cleansed  with  a  1-3000  bichloride  sol. 
and  the  wound  with  a  saturated  solution  of  bo- 
racic  acid. 

The  patient  was  kept  in  a  sitting  posture 
until  the  eighth  day,  then  gradually  lowered 
until  twelfth  day.  When  discharged  the 
wound  was  healed  and  no  parasites  could  be 
found  in  his  blood. 

This  case  was  diagnosed  and  after  treatment 
given  by  me  while  in  charge  of  colored  wards 
as  substitute  interne,  Wilmington,  N.  C,  City 
Hospital,  from  June  to  September,  inclusive, 
1908. 


CORRESPONDENCE. 


SOME  EXPERIENCES   IN   THE  VALLEY 
OF  THE  AMAZON. 

(Concluded  from  February  Number) 

This  is  the  first  night  on  shore  for  over  a 
month ;  although  we  were  at  Para  for  two  days, 
sundown  was  the  signal  for  a  quick  get-away  to 
the  Ravelston,  and  the  anti-mosquito  cottage  on 
board.  Dr.  Lovelace  was  one  of  the  pale-faced 
persons  who  came  down  to  see  our  boat  tie  up  to 
the  bank.  He  appears  to  be  a  good  one,  and  will 
take  charge  of  the  hospital  in  a  few  days.  Porto 
Velho  is  a  very  queer  place.  A  space  of  about 
ten  square  acres  has  been  cleared  and  a  general 


THE   HOSPITAL   BULLETIN 


store,  the  commissary  and  buildings  for  the  engi- 
neers have  been  erected.  A  wall  of  dense  vege- 
tation surrounds  this  clearing.  You  will  see  by 
the  photograph  that  they  are  not  little  fellows. 
They  are  giants.  The  smallest  is  at  least  8  feet 
in  diameter  ioo  feet  above  the  ground.  Its 
lowest  branches  would  just  about  escape  the  top 
of  the  Washington  Monument,  if  placed  along- 
side of  Baltimore's  patriotic  effort. 

Supper  was  not  bad,  and  these  aenemic  engi- 
neers are  at  least  optimistic. 


is  to  meet  me  just  above  the   Falls  and  paddle 
me  up  stream  for  two  days  to  San  Carlos. 

*  *  *  *  * 

This  wonderful  trip  will  never  be  forgotten. 
The  canoe  kept  close  to  the  shore  at  times,  and 
it  was  almost  like  rowing  through  a  great  con- 
servatory. The  river  is  high  and  the  trees  and 
vines  trail  in  the  water.  Alligators  are  almost 
everywhere,  and  parrots  and  monkeys  constantly 
remind  you  of  their  presence  with  their  shrill 
cries.    *  >ften  the  rowers  had  to  get  out  of   the  boat 


BOATS    LOADING     TO    GO    UP    THE    MADIERA    RIVER     ABOVE!    SAN    ANTONIO 


Next  to  the  pickle  jar  was  a  large  bottle  of 
quinine.  Nearly  every  man  took  10  grains.  Some 
took  more,  and  all  wanted  to  know  the  latest 
news  from  the  States.  Two  of  the  men  had  only 
left  the  table  for  a  few  moments  when  they  sep- 
arated themselves  from  their  supper.  Poor  fel- 
lows !    It's  "Algride"  with  them,  I  think. 


I  left  Porto  Velho  today  in  a  launch  for  San 
Antonia,  where  tonight  will  be  spent.  An  Ameri- 
can Indian,  who  was  in  the  army  in  the  Philip- 
pines, is  with  me  to  act  as  interpreter  and  ser- 
vant.    At  daybreak  a  canoe  with  native  rowers 


and  draw  it  with  a  long  rope  past  some  particu- 
larly rapid  place  in  the  river.  When  the  canoe 
reached  Tietonia  the  canoe  was  tied  up  below  the 
balls  and  the  cargo  was  unloaded  and  carried 
above  the  Falls  to  a  small  warehouse,  preparatory 
in  being  placed  on  another  canoe  which  is  waiting 
to  go  up  the  river  at  daybreak.  *  *  I  was  most 
fortunate  last  night,  and  instead  of  sleeping  in  a 
hammock,  spent  a  pleasant  evening  and  had  a 
good  dinner  at  the  house  of  a  Spaniard  who  is 
agent  for  a  wealthy  firm  of  rubber  exporters. 

The  Falls  are  not  particularly  high,  but  the 
volume  is  probably  three  times  as  great  as  that 
of  Niagara,  and  the  roar  is  deeper  and  stronger. 


THE    HOSPITAL   BULLETIN 


I  stood  there  in  the  gray  dawn  and  watched  these 
native  rubber  bearers  who  were  carrying  the  rub- 
ber around  the  Falls  to  be  put  in  the  canoe  below, 
shuffle  along.  Each  had  a  great  ball  of  rubber 
on  his  head.  Outside  of  the  roar  of  the  falling 
waters  there  was  not  a  sound,  and  Dore  must 
have  seen  some  such  weird  place.  His  pictures 
would  lead  you  to  believe  that  he  had.  After  what 
I  have  seen  today  I  really  don't  care  very  much  if 
I  do  get  sick  up  country.  San  Carlos  was  reached 
in  good  time.  San  Carlos  is  on  the  map  and  printed 
in  letters  large  enough  to  give  the  impression  of 
a  village,  at  least.  San  Carlos  consists  of  a 
thatched  three-room  hut  and  a  long  shed  for  the 
16  pack  mules.  I  have  seen  this  deceptive  way  of 
marking  even  cross-road  stations  in  Iceland  and 
Norway  also.  I  found  here  a  Mr.  T..  who  is  bad 
with  the  fever.  He  was  carried  down  yesterday 
in  a  hammock  by  eight  natives.  Quinine  will  fix 
him  right,  I  think.  The  storehouse  keeper  is  out 
of  his  head  and  raving  away  at  a  great  rate.  It 
may  be  just  fever,  but  I  think  he  has  poisoned 
himself  with  too  much  quinine. 

Tomorrow  the  start  will  be  made  for  the  in- 
terior, since  the  mule  train  has  arrived.  The 
mule  team  master  is  lame  with  a  big  ulcer  on 
his  leg.  A  tropical  ulcer,  no  doubt,  and  he  refuses 
to  let  me  clean  and  dress  it. 

Bags,  scope  and  outfit  were  packed  on  mules 
and  a  seven-hour  ride  over  a  rough  trail  brought 
me  to  the  front.  You  can't  describe  such  a  ride 
as  this.  So  dense  is  the  vegetation  that  the  sun's 
rays  reach  the  earth  only  as  long  pencils  of  light. 
Wonderfully  brilliant  butterflies  flutter  about  in 
the  cleared  trail,  and  when  they  chance  to  cross  a 
slanting  sunbeam  for  an  instant  they  flash  into 
view  like  an  explosion  of  burning  color. 

It  is  hard  to  imagine  the  effect  they  produce  as 
their  wings  flash  and  close  and  flash  again  in 
the  sunlight.  In  places  the  trail  is  carpeted  with 
fallen  blossoms  inches  deep.  Pale  pink,  deep 
blue,  lavender,  orange,  almost  every  color  of  the 
rainbow.  We  marvel  at  the  beauties  of  some  of 
our  great  conservatories,  but  in  comparison  with 
this  wonderland  they  sink  to  the  level  almost  of 
the  toy  gardens  some  diligent  fathers  build  under 
the  Xmas  trees  for  their  own  as  well  as  their 
childen's  delight.  Monkeys,  small  and  large, 
scamper  along  and  peer  down  at  you.  Twice  dur- 
ing the  day  I  saw  enormous  spiders.  One  killed 
by  an  engineer  measured  eleven  and  three-quar- 
ler  inches  from  one  front  to  the  opposite  hind  leg. 


Hard  to  believe,  I  know,  but  a  twenty-five  foot 
four  inch  snake  was  killed  by  our  preliminary 
party.  Bichloride  was  all  I  had  to  prevent  its 
skin  from  rotting,  and  a  severe  illness  from 
bringing  it  back  to  the  States  with  me. 

The  camp  was  reached  before  dark  and  a  cor- 
dial welcome  awaited  my  guide  and  myself.  Of 
the  14  white  men  in  camp  three  were  quite  sick 
and  several  others  about  as  an  anaemic  a  looking 
lot  as  I  ever  saw.  Of  the  40  odd  laborers  I 
learned  later  jj  per  cent,  had  been  sick  during 
June.     *     :::     * 

We  are  now  in  a  part  of  the  world  unknown 
before  to  white  men.  Parrot  soup  and  fried 
monkey  were  served  at  my  first  meal.  Monkey 
meat  is  very  tough.  Put  the  photograph  of  the 
camp  will  show  you  how  wild  this  country  is. 
Wild  pigs  are  good  to  eat,  but  hard  to  shoot,  and 
so  parboiled  parrots  and  rice  soup  made  from 
them  is  at  times  acceptable,  and,  except  for  the 
toughness  of  it.  monkey  meat  is  not  at  all  bad. 


The  2,000-mile  journey  up  stream  is  over  and 
our  ship  is  already  tied  to  the  banks  at  Porto " 
Velo,  near  San  Antonio.  We  should  have  landed 
an  hour  ago,  but  there  was  some  trouble  with  the 
custom  officers.  Every  boat  that  comes  up  the 
Amazon  must  bring  along  two  pilots  and  two 
custom  officers  from  Para.  The  pilots  draw  enor- 
mous salaries  and  are  very  big  people.  And  they 
are  grafters  of  the  first  water.  It  is  reported 
that  when  we  left  Serpa  it  was  necessary  for  Mr. 
M.  to  hand  out  6  Cantos  before  the  freight 
steamer  could  have  a  clean  bill.  A  Canto  is  one 
thousand  milres,  or  about  $320.  And  all  this 
after  the  duties  had  been  properly  attended  to  at 
Para  before  leaving  there. 

Either  most  of  the  people  are  far  from  well  or 
there  is  a  tropical  look  which  one  may  get  used  to 
later.  We  are  not  yet  landed,  but  all  of  the 
people  from  the  camp  near  the  top  of  the  bank 
have  come  down  close  to  the  boat.  They  look  far 
from  strong  and  walk  as  though  they  were  just 
out  of  bed.  convalescing  from  a  typhoid  fever 
attack. 

Here  at  Porto  Velo  I  am  making  hasty  but 
complete  preparation  to  go  up  the  river,  where  I 
will  join  the  preliminary  exploration  party  which 
has  penerated  into  a  part  of  the  jungle  never 
before  seen  by  white  men. 


It  seems  almost  impossible  for  me  to  get  along 


THE   HOSPITAL   BULLETIN 


to  Beri-Beri,  tropical  ulcers,  dysentery,  and.  most 
of  all,  malaria. 

It  must  be  borne  in  mind  that  the  people  of  this 
region  come  from  many  parts  of  the  world.  They 
are  contract  laborers,  brought  from  the  Isthmus, 
Spain,  Portugal  and  from  the  coast.  They  are 
brought  to  work  on  the  new  railway.  They  get 
sick,  and  mostly  they  are  sent  home  as  per  con- 
tract. They  don't  last  long-.  Latent  diseases  de- 
velop shortly  after  arrival  at  headquarters.  Sub- 
tertian  malaria,  shown  by  blood  examination  of 
many  new  arrivals,  required  less  than  a  month  to 
spring  into  life  after  locating  in  the  fever  zone. 
Every  one  of  them,  and  the  engineers  also,  get 
the  fever  without  exception.  Everything  is 
grafted  on  malaria.  The  anapholes  leads  the 
German.  Anklastoma  and  Ascaris  Lumbracoides 
bring  up  the  rear.  Tropical  ulcers  are  present  in 
many  cases  and  are  often  bilateral. 

One  of  the  most  interesting  diseases  observed 
was  tick  fever.  I  was  fortunate  in  having  two 
cases  to  study  in  a  period  of  nearly  two  months, 
and  I  will  give  the  history  of  one  case  later.  Why 
more  cases  did  not  develop  is  odd,  for  each  night 
it  was  necessary  to  search  carefully  and  remove 
the  day's  crop.  It  was  a  continual  case  of  sweat 
bees,  stinging  flies  and  piums.  There  are  surely 
chances  for  infection  not  yet  known.  Later  many 
of  the  undifferentiated  fevers  will  be  better  un- 
derstood and  their  etiology  is  only  a  matter  of 
time.  Very  truly. 

Albert  1 1.  Carroll,  M,  1). 


.Mcdowell  hall,   historic   main 

p.uilding  at  st.  john's  college, 

department  of  arts  and 

sciences,  destroyed 

BY  FIRE. 

McDowell  Hall,  named  after  John  McDow- 
ell, LL.  D.,  first  president  of  St.  John's,  the 
main  building  at  St.  John's  College,  Annapolis, 
was  destroyed  by  fire  February  20,  1909. 

The  fire  started  in  the  upper  part  of  the 
structure  and  rapidly  spread  to  the  cupola. 
Practically  all  of  the  furnishings  of  any  value 
were  saved,  including  the  equipment  of  the 
fraternity  rooms,  college  records  and  the  large 
and  valued  collection  of  class  shields  that 
adorned  the  balconies  of  the  chapel  ball. 

The  destruction  of  the  building  is  practically 
complete,  a  section  of  the  east  wall  some  seven 


feet  deep  having"  tumbled  down,  and  it  is 
thought  probable  that  other  parts  of  the  wall 
have  been  weakened  to  such  an  extent  that 
they  will  fall.  The  falling  of  the  wall  caused 
much  regret  among  the  college  authorities,  as 
the  plan  of  rehabilitating  the  structure  with 
the  use  of  the  original  walls  had  been  dis- 
cussed, and  much  of  the  historical  interest  of 
the  building,  therefore,  would  have  been  re- 
stored. 

The  loss  to  the  structure  and  contents  of 
over  840,000  is  covered  partially  by  insurance 
of  $25,000. 

McDowell  Hall,  the  oldest  building  of  the 
college  group,  is  one  of  the  most  interesting  of 
the  historic  buildings  of  Annapolis.  It  was  be- 
gun in  1744  by  Governor  Thomas  Bladen,  but 
the  legislature  of  the  colonies  decided  that  he 
had  exceeded  his  power  in  appropriating  the 
money  for  the  erection  of  the  building  and  or- 
dered the  work  stopped. 

It  remained  partly  completed  until  1784, 
when  the  building  and  ground  upon  which  it 
stood  was  transferred  to  King  William  School, 
which  then  became  St.  John's  College,  and  the 
money  for  its  completion  was  appropriated  by 
the  state. 

Since  that  time  it  has  been  used  as  the  main 
building  of  the  college  group.  In  1886  the  cu- 
pola was  set  on  fire  by-  a  bolt  of  lightning,  but 
the  fire  was  extinguished  without  serious  dam- 
age being  done. 

In  front  of  the  building  stands  the  "liberty 
tree,"  a  tulip,  under  which  it  is  said  a  treaty 
with  the  Indians  was  made. 

The  friends  of  liberty  also  held  meetings  under 
the  tree  in  the  days  just  before  the  Revolution. 
The  tree  is  supposed  to  be  older  than  Annapolis. 

Unanimously  moved  by  the  determination 
that  a  more  ample  McDowell  Hall  should  rise 
from  the  ruins  of  the  old  one,  and  that  the  new 
structure  should  be  built  upon  the  lines  of  the 
old,  and  be  included  as  far  as  possible  within 
its  historic  walls,  the  movement  for  the  recon- 
struction was  launched  at  an  enthusiastic  meet- 
ing of  the  alumni  and  influential  friends,  which 
was  held  in  the  college  library  February  25, 
1909.  The  meeting  went  into  the  consideration 
of  the  resolutions  which  were  to  be  presented 
to  the  board  of  visitors.  The  resolutions  sug- 
gested that  architects  be  employed  to  test  the 
possibility-  of  retaining  the  old  walls  and  to  de- 


8 


THE    HOSPITAL   BULLETIN 


vise  plans  for  the  rebuilding,  with  such  wings 
and  additions  as  would  not  destroy  the  old  plan 
or  disassociate  it  with  its  historic  traditions. 
The  cost  of  the  new  building  was  placed  at  ap- 
proximately $100,000.  The  resolutions  further 
urged  that  a  committee  be  appointed  at  once  to 
lay  the  claim  of  the  institution  before  the  pub- 
lic, and  particularly  before  men  and  women 
of  wealth  and  philanthropic  disposition  and  be- 
fore the  custodians  of  public  educational  funds. 

After  the  passage  of  this  resolution  another 
resolution,  offered  by  Judge  Henry  D.  Harlan, 
of  Baltimore,  a  graduate  of  the  college,  provid- 
ing for  the  appointment  of  an  alumni  committee 
on  the  rebuilding  of  McDowell  Hall,  was  carried. 
The  committee  will  be  appointed  later. 

At  the  conclusion  of  the  formal  business  Mr. 
Poe  presented  the  resolutions  of  regret  and  sym- 
pathy of  the  Regents  of  the  University  of  Mary- 
land, of  which  St.  John's  is  the  academic  depart- 
ment. 


DO  IT  NOW, 


According  to  an  editorial  in  the  February  issue 
of  The  Hospital  Bulletin,  the  long-cherished 
dreams  of  a  president  of  the  University  of  Mary- 
land appears  to  be  a  possibility  of  the  not  distant 
future.  Announcement  of  the  creation  of  this 
<  rffice  and  its  first  incumbent  may  be  announced 
at  any  moment  by  the  Board  of  Regents,  who 
have  at  last  come  to  recognize  the  disadvantage 
under  which  our  institution  labors  before  the 
public,  alumni,  benefactors  and  sister  institutions. 
That  the  Board  of  Regents  has  appointed  a  com- 
mittee from  its  number  to  investigate  and  report 
the  ways  and  means  of  providing  a  president,  is 
indeed  welcome  news  to  all  loyal  alumni.  For 
some  time  alumni  have  been  agitating  the  crea- 
tion of  this  office,  and  the  appointment  of  this 
committee  was  the  result.  The  Regents  are  to 
be  congratulated  upon  this  move,  which  should 
forever  hush  the  accusations  that  the  institution 
is  being  run  solely  in  the  interest  of  the  members 
of  the  several  faculties. 

Now  it  is  up  to  the  alumni  to  aid  and  abet  the 
Regents  in  every  way  possible  to  consummate 
such  a  desirable,  yea  necessary,  change.  Let's 
cease  petty  carpings  and  whoop  it  up.  Let's  pre- 
sent a  solid  front  and  show  devotion  and  loyalty 
by     providing    at     least    a    partial    endowment 


towards  a  presidency.  In  no  other  way  could 
the  alumni  more  materially  manifest  an  earnest 
in  this  movement.  Every  alumnus  should  be  not 
only  willing,  but  glad  to  aid  in  the  procurement 
of  a  president.  If  the  alumni  have  ever  felt  a 
tinge  of  love  for  the  University,  any  pride  in  its 
past  glories,  any  hope  of  future  greatness,  this  is 
the  time  of  times  to  express  it  in  a  material  way. 
If  one  ever  contemplate  doing  anything  for 
Alma  Mater,  do  it  now,  for  ye  knoweth  not  what 
tomorrow  bringeth  forth. 

Another  matter  which  shows  the  Regents  alive 
to  the  need  of  the  times  is  the  cordial  reception 
given  a  petition  from  the  General  Alumni  Asso- 
ciation imploring  the  creation  of  a  Board  of 
Alumni  Counsellors.  This  has  likewise  been  re- 
ferred to  a  special  committee  for  mature  and 
deliberate  consideration.  To  be  candid,  the  Re- 
gents recognize  the  defective  organization  under 
which  they  are  laboring,  and  if  proper  support 
and  encouragement  is  extended  to  them,  this  no 
doubt  will  be  changed.  Indeed,  there  is  talk  of 
petitioning  the  next  Legislature  for  a  new  char- 
ter. The  burden  of  managing  such  extensive 
property  interests  has  become  too  onerous  to  the 
professors,  who  are  more  than  willing  to  transfer 
this  trust  to  other  shoulders,  provided  the  change 
will  not  bring  chaos.  It  is  no  more  than  just  that 
our  alumni  meet  this  spirit  of  sacrifice  with  as 
much  sacrifice  upon  their  part.  Here  is  your 
long-sought-for  opportunity  to  aid  in  the  uplift 
of  our  dearly  beloved  University.  See  that  you 
make  the  best  use  of  your  opportunities.  Deny 
yourself  something  to  render  her  a  service,  not 
necessarily  pecuniary;  attendance  of  the  meet- 
ings of  the  General  Alumni  Association,  a  body- 
organized  for  the  creation  of  the  "University 
Idea,"  a  fosterer  of  all  which  is  good  for  the 
University,  a  body  which  has  from  its  inception 
worked  constantly  against  almost  insurmountable 
barriers  for  the  placing  of  the  University  upon  a 
sound  basis,  a  body  which  has  the  temerity  to 
petition  the  Regents  for  a  general  Centennial 
Celebration  and  a  paid  head  for  the  institution, 
but  also  for  a  Board  of  Alumni  Counsellors,  is  a 
most  valuable  service.  Show  your  interest  in  our 
institution  by  your  presence ;  you  have  been 
clamoring  for  recognition  ;  show  your  loyalty  and 
sincerity  by  attending  the  meetings  of  the  Gen- 
eral Alumni  Association,  where  these  momentous 
questions  are  under  consideration  and  delibera- 
tion. Al.UMNUS. 


THE   HOSPITAL   BULLETIN 


9 


THE  HOSPITAL   BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

EDITED    BY 

A   COMMITTEE    OF   THE    HOSPITAL   STAFF 


PUBLISHED   BY    THE 

HOSPITAL   BULLETIN   COMPANY 
University  of  Marvland 


Business  Address, Baltimore,  Md. 

Editorial  Address,   ....     University  of  Maryland 


Baltimore,  Md.,  March  15,  1909 

EDITORIAL. 

Beginning  of  Volume  V. — With  the  present 
issue  The  Bulletin  begins  its  fifth  year  of  pub- 
lication. In  looking  back  over  the  four  years 
past  the  L<litor  and  Business  Manager  of  The 
Bulletin  have  cause,  both  for  satisfaction  and 
for  regret.  It  is  some  satisfaction  to  have  kept 
the  regular  monthly  issues  before  its  many  read- 
ers when  the  difficulties  of  the  task  and  the  many 
embarrassments  which  are  associated  with  the 
publication  are  taken  into  consideration.  It  is  a 
source  of  regret  to  know  that  The  Bulletin 
has  not  reached  the  high  standard  which  is  to  be 
desired.' 

When  it  is  borne  in,  mind  that  The  BULLETIN 
is  a  class  organ  dependent  upon  a  single  class  of 
readers  and  subscribers,  it  can  be  readily  under- 
stood bow  difficult  it  has  been  to  obtain  matter 
for  its  reading  columns  and  money  to  meet  its 
business  obligations.  That  The  Bulletin  could 
be  made  a  much  better  publication  than  it  is  the 
editor  is  painfully  aware.  If  he  has  not  done 
the  best  he  could,  he  has  done  the  best  that  it 
was  possible  for  him  to  do  under  existing  cir- 
cumstances. The  editor  has  many  and  pressing 
duties  calling  for  his  time  and  energies  apart 
from  the  work  he  has  given  to  The  Bulletin. 
He  has  only  worked  for  The  Bulletin  from 
force  of  necessity,  because  up  to  the  present  time 
he  has  not  been  able  to  impose  this  work  on  an- 
other's shoulders.  His  desire  to  see  the  publica- 
tion live  and  do  a  service  to  Alma  Mater  and  to 
her  Alumni  has  been  the  only  motive  which  could 
have  held  him  to  the  job  for  four  years. 

The  time  is  near  at  hand  when  some  younger 
and  more 'capable 'man  connected  with  the  Med- 
ical Department  of  the  University  should  take 
up  the  entire  management  of  The  Bulletin  and 
relieve  its  present  tired-out  representative.     It  is 


earnestly  hoped  this  individual  will  be  found  at 
no  remote  date.  The  Bulletin  needs  not  only 
a  more  energetic  and  progressive  editorial  man- 
agement, but  it  most  urgently  needs  a  more 
capable  business  head.  In  this  age  brains  and 
money  are  essential  to  progress.  The  man  who 
has  the  brains  to  do  good  work  and  the  money 
to  aid  in  the  development  of  an  enterprise  is  the 
man  who  will  get  results.  The  Bulletin  looks 
for  no  marked  progress  in  its  work  until  this 
man  is  found. 

Recognizing  the  shortcomings  of  the  present 
management  of  The  Bulletin,  it  is  but  fair  to 
state  that  the  alumni  and  friends  of  the  Univer- 
sity owe  something  to  the  publication  which  has 
tried  to  serve  them  for  four  years.  If  a  more 
liberal  financial  and  literary  support  was  given 
The  Bulletin  would  soon  be  able  to  reflect  this 
support  in  its  reading  matter.  When  an  editor 
is  forced  to  beg  for  material  and  to  dun  his  read- 
ers for  money  his  amiability  is  sorely  taxed  and 
his  work  is  unsatisfactory. 

The  Fire  at  St.  John's  College.  —  The 
Alumni  of  the  University  of  Maryland  will 
learn  with  deep  regret  of  the  recent  destruction 
by  fire  of  the  venerable  McDowell  Hall,  at  St. 
John's  College.  This  old  building  possessed 
not  only  a  practical  value,  but  an  historic  in-, 
lerest.  Its  loss  is  one  which  cannot  be  restored 
in  full. 

Since  St.  John's  College  has  become  by  af- 
filiation the  Department  of  Arts  and  Sciences 
of  the  University  a  strong  bond  of  union  has 
grown  up  between  the  different  departments, 
and  the  ties  of  interest  and  friendship  have 
been  greatly  strengthened.  Any  misfortune, 
coming  to  any  one  department  will  be  keenly 
felt  by  all  departments  of  the  University. 
I  lence  the  sympathies  of  all  of  the  Alumni,  will 
go  out  to  St.  John's  in  her  recent  loss.  It  is  an 
ill  wind  which  blows  no  good.  The  Bulletin 
believes  that  the  loss  sustained  by  St.  John's 
will  in  the  end  work  greatly  to  her  advantage — 
that  she  will  arise  from  her  ashes  with  renewed 
vigor  and  purpose,  and  with  a  modern  equip- 
ment for  her  educational  work.  The  growth  of 
St.  John's  during  recent  years  has  been  marked 
for  thorough  and  progressive  methods.  Not 
only  has  she  grown  in  number  of  students  and 
in  the  high  character  of  her  teaching  body,  but 
she  has  improved  her  courses  of  instruction  to 


10 


THE   HOSPITAL   BULLETIN 


meet  the  standards  of  the  leading  colleges  of 
this  country. 

The  military  and  educational  training  she 
gives  her  students  will,  we  believe,  measure  up 
to  that  given  by  any  college  of  like  character 
in  America.  The  location  of  St.  John's  at  An- 
napolis, the  capital  of  the  state,  is  exception- 
ally fortunate.  The  social  life  and  healthy  en- 
vironment of  Annapolis  give  a  valuable  stim- 
ulus to  student  life  in  that  community.  With 
the  Naval  Academy  and  St.  John's  College  An- 
napolis has  become  an  educational  center  of 
wide  distinction.  The  association  of  large  stu- 
dent bodies  and  large  corps  of  teachers  with 
the  refined  society  of  the  capital  of  the  state  is 
highly  beneficial  to  all  classes. 

The  Bulletin-  indulges  the  hope  that  the 
burning  of  McDowell  Hall  will  call  attention 
to  the  claims  of  St.  John's  College  upon  the 
people  of  Maryland,  and  that  our  legislature 
will  deal  generously  with  this  venerable  school, 
which  has  so  long  served  the  youth  of  our  state. 


ST.  JOHN'S  LOSS. 

There  is  more  than  the  usual  loss  in  the  burn- 
ing of  any  of  the  old  buildings  at  Annapolis. 
One  around  which  history  clustered  with  special 
interest  was  McDowell  Hall,  and  its  destruction 
on  Saturday  was  a  great  misfortune. 

Friends  may  and  should  rush  to  give  to  St. 
John's  a  main  building  that  will  take  its  place  and 
have  many  comforts  and  facilities  which  Mc- 
Dowell did  not  possess,  but  nothing  can  possess 
that  peculiar  value  which  comes  from  the  long 
association  of  many  distinguished  names. 

In  this  connection  it  is  worth  while  to  remem- 
ber that  St.  John's  College  has  done  great  work 
for  Maryland,  and  that  it  ought  to  have  a  larger 
support  from  the  people  of  the  state.  The  re- 
building of  McDowell  Hall  might  very  appro- 
priately he  the  beginning  of  a  new  era  in  the  life 
of  the  college.  It  presents  a  fine  opportunity  for 
its  well-to-do  and  public  spirited  alumni. — Edi- 
torial, Star. 


HOSPITAL  SHIP  FOR  THE  POOR—  HAR- 
BOR ENGINEER  LACKEY  INDORSES 
MR.  HELLER'S  PLAN. 

City  Councilman  Heller  has  introduced  in  the 
City  Council  a  resolution  providing  fur  the  ap- 
pointment of  a  commission  to  report  <>n  plans  for 


the  establishment  by  the  city  of  a  hospital  ship 
in  summer  for  the  poor.  Harbor  Engineer 
Lackey  is  in  accord  with  the  suggestion,  and  has 
promised  to  co-operate  in  the  project. 

The  vessel  would  be  used  by  poor  sick  people 
and  would  make  daily  trips  on  the  hay.  Efforts 
would  be  made  to  have  it  accommodate  1,000.  Mr. 
Lackey  said  such  a  boat  could  be  built  for  $30,000 
and  has  suggested  that  churches,  lodges  and  busi- 
ness and  improvement  associations  may  be  gotten 
interested  in  it,  and  the  ship  be  built  by  pop- 
ular subscription  and  maintained  by  the  city. 


A  MOCK  TRIAL. 


Under  the  Direction  of  Joseph  T.  Smith,  M.  D., 

Department  of  Medicine;  Mr.  Eli  Frank, 

Department  of  Law. 

Reported  by  J.  T.  S. 

On  the  evenings  of  February  12th  and  13th 
a  mock  trial  was  held  in  Davidge  Hall  in  which 
students  from  the  Medical  and  Law  Departments 
took  part.  The  synopsis  of  the  case  was  as 
follows : 

(  )n  the  morning  of  December  10th  William 
(iillis  died,  and  James  Atchison,  his  nephew, 
is  charged  with  causing  his  death  by  the  ad- 
ministration of  tartar  emetic.  The  circum- 
stances are  as  follows: 

William  had  been  sick  for  a  week,  complain- 
ing of  headache,  nausea  and  weakness.  He  was 
a  man  of  sixty  years  of  age  and  always  en- 
joyed good  health.  At  times,  however,  he 
would  indulge  in  drink,  but  had  not  for  some 
weeks  before  his  last  sickness.  His  physician 
in  attendance  could  find  no  special  cause  for 
the  trouble,  and  as,  under  treatment  to  allay 
the  symptoms,  his  patient  improved,  he  was 
satisfied. 

( )n  the  morning  of  December  9th  William 
did  not  seem  so  well — had  more  headache  and 
vomited  for  the  first  time.  The  physician  saw 
him  twice  that  day,  and.  although  his  patient 
had  vomited  several  times,  he  was  not  able  to 
see  the  vomited  matters,  as  they  were  thrown 
out  before  his  arrival.  At  midnight  the  doctor 
was  hastily  summoned,  as  the  messenger  said 
'tis  patient  was  much  worse.  Upon  arrival  he 
found  his  patient  delirious,  and  soon  after  con- 
vulsions set  in.  These  were  relieved  by  the 
administration  of  chloroform,  but  recurred 
when  the  influence  of  the  drug  wore  oft*.    After 


THE   HOSPITAL   BULLETIN 


11 


working  with  him  until  7  A.  M.,  the  man  broke 
out  into  a  cold  perspiration,  collapse  set  in.  and 
the  man  died  at  8  A.  M. 

The  vomited  matters,  having  been  thrown 
out.  could  not  be  bad  for  examination.  The 
physician,  from  the  condition  of  his  patient, 
suspected  poison,  and  in  looking  about  found 
a  tumbler  in  a  cupboard  in  the  bottom  of  which 
was  a  small  quantity  of  a  white  sediment. 
This,  upon  analysis,  proved  to  be  tartar  emetic. 
His  nephew,  who  was  his  constant  attendant 
and  the  heir  to  his  fortune,  was  accused  of  ad- 
ministering small  amounts  of  tartar  emetic, 
and,  not  getting  the  results  he  desired,  finally 
gave  him  a  larger  dose.  The  sediment  in  the 
glass  he  alleged  was  left  over  from  some  he 
had  used  in  making  a  poison  paste  for  rats. 
While  no  tartar  emetic  was  found  in  the  stom- 
ach, it  was  contended  that  its  absence  proved 
nothing,  as  it  might  have  all  been  thrown  up 
at  the  time  of  the  vomitings.  The  mucus  mem- 
branes showed  congestions,  as  did  the  stomach, 
but  as  it  was  known  that  the  man  had  taken 
powders  to  control  his  drink  habit,  and  as  it 
was  known  that  these  contained  antimony,  the 
defense  alleged  that  the  man  had  been'  taking 
some  of  the  powders  before  he  was  taken  sick. 
It  was  proved  that  he  had  taken  none  of  them 
during  his  sickness,  and  that  the  congestions 
were  due  to  the  tartar  emetic  in  said  powders. 

The  court  proceedings  were  carried  on  with 
all  the  detail  and  dignity  of  a  real  court  of  jus- 
tice, those  present  rising  and  standing  until  the 
judge  took  his  seat,  the  crier  calling  the  court 
to  order,  the  calling  of  the  roll  of  the  jurors, 
clerk,  reporter,  counsel  and  witnesses,  both  or- 
dinary and  expert.  The  court  was  constituted 
as  follows: 


Witnesses  for  Defense: 


Judge — Eli   Frank. 
Clerk — G.  C.   Feurst. 
Crier — 

Geo.  McG.   Benson. 
Bailiff— Benj.  Reck. 
State's  Attorney— 

R.  Legare  Welti). 


A.-sist.    State's    Attorney. 

Samuel  J.   Fisher. 
Counsel    for     Defense — 

Frank  B.   Evans  and 

A.  H.  Siskend. 
Sheriff— W.  Lnn. 
Prisoner — Mr.   Ebert. 


Witnesses   for  the  Prosecution: 


Family   Physician — 
Charles  Schmidt. 

Chemist — 
H.  W.  Coddington. 

Butler- 
Raymond  C.   Reik. 


Post-Mortem.  Physician, 

Jose  Igartua. 
Druggist   Relief   Clerk— 

Jas.  G.   Edelen. 


Chemist — 

R.  C.  Howard. 
Medical  Expert — 

J.  Ostro. 
Prisoner — Mr.    Ebert. 


Medical   Expert — 

I.  M.  Macks. 
Chemist— Mr.   Alfeld 
Druggist — 

E.  E.  Nichols. 


Jurymen: 


R.    E.   Jones,    Foreman: 

E.   H.    W'ooten, 

E.   E.   Hearn. 

Arthur  Trader. 

W.  H.  Chambers, 

S.  E.  Mueller. 


David   Ford. 
Mr.  Wolf, 
J.  J.  Greengrass, 
Mr.  Mullen, 
.Mr.  Hubbard. 
Mr.  Backrack. 


The  attendance  of  the  students  was  excel- 
lent, and  all  seemed  greatly  interested  in  the 
proceedings,  which  were  instructive,  with  just 
enough  variety,  and  at  times  amusement,  to 
prevent  monotony.  The  judge  presided  with 
dignity,  and  was  called  upon  on  several  occa- 
sions for  his  decision,  owing  to  the  disagree- 
ments of  counsel.  The  disagreements  of  coun- 
sel, the  objections  of  one  side  to  the  questions 
of  the  other,  and  the  discussions  arising  there- 
from, gave  all  present  a  good  insight  into  the 
way  lawyers  watch  the  interests  of  their 
clients.  The  excellent  examinations,  cross-ex- 
aminations and  re-examinations  presented  the 
manner  of  securing  evidence  in  a  most  favor- 
able light.  Much  amusement  was  occasioned 
when,  upon  cross-examination,  a  witness  was 
asked  to  state  the  difference  between  antimony 
and  alimony.  Upon  the  question  being  ob- 
jected to,  counsel  said  he  was  trying  to  test  the 
general  knowdedge  of  the  witness.  The  judge 
allowed  the  witness  to  answer.  An  old  man 
1  the  chum)  came  in  with  a  cane  and  books 
under  his  arm,  and  well  represented  the  garru- 
lous witness.  The  medical  experts,  the  chem- 
ical experts,  the  butler  and  the  family  physi- 
cian did  themselves  great  credit  as  witnesses, 
and  presented  such  a  variety  as  to  make  that 
portion  of  the  trial  intensely  interesting  and  in- 
structive. The  introduction  of  a  glass  having 
a  sediment  and  of  the  record  of  the  druggist 
with  an  erasure  added  to  the  interest.  The  age 
of  some  of  the  witnesses,  the  possession  of  an 
automobile  by  one,  the  length  of  time  another 
had  been  in  practice  and  the  prize  obtained  by 
a  third  for  a  paper  on  tartar  emetic  afforded 
much  amusement.  The  speeches  of  counsel  at 
the  close  were  listened  to  with  interest,  the  ar- 
raigning  of  the   opposition   witnesses   by   one. 


12 


THE   HOSPITAL   BULLETIN 


the  fervid  eloquence  of  another  and  the  careful 
presentation  of  the  testimony  of  the  witnesses 
bv  a  third  made  a  pleasing  and  interesting  va- 
riety, and  exhibited  in  a  most  engaging  manner 
the  diverse  ways  in  which  the  jury  receive  the 
important  points  in  regard  to  a  case  and  have 
presented  to  them  the  matters  testified  of  by 
the  witnesses. 

All  present  were  gratified  by  the  ability  dis- 
played by  the  students,  for  it  was  left  entirely 
to  them  to  work  out  antl  present  the  case. 

This  is  the  first  attempt  of  the  kind  that 
has  been  made,  and  it  was  successful  in  giving 
the  students  a  clear  insight  into  court  proceed- 
ings and  cil  bringing  about  a  more  intimate  re- 
lationship between  the  Medical  and  Law  De- 
partments, a  relationship  which,  if  it  were  as- 
siduously cultivated,  would  do  much  towards 
promoting  a  more  sympathetic  feeling  between 
these  great  professions  when  the  students  go 
"lit  as  active  physicians  and  lawyers. 


[TEMS. 


THE  CANDIDATE'S  PRAYER. 


Dr.  R.  C.  Buqk,  of  the  class  of  1S74,  now 
practicing  his  profession  with  success  and  dis- 
tinction at  Garrison ville,  Va.,  writes  to  the  ed- 
itor of  The  Bulletin  that  the  following  verses 
were  removed  by  him  from  the  Bulletin  Board 
in  the  hall  of  the  University,  and  have  been 
kept  by  him  as  a  souvenir  for  the  past  35  years. 
The  author,  he  thinks,  was  Dr.  Norris,  of  his 
class,  long  since  dead  : 

My  carpus  anil   each  phalanx   is 

Jagg'd.  numb  and  worn  and  cramped; 

My  poor  encephalbn  o'ertaxed, 
My  energies  all  damped. 

My  conjunctivae  arc   suffused. 

With   films   my   iris  hooded; 
My   Dura   Mater's   sinuses 

Willi    tun   much   blood   arc   flooded. 

And   O,   my  nervous  system   is 

All   shattered   and  o'erstrung; 
The   ei mstant   studying  because 

The  "physic-books"  among. 

My    stomach   does   but   ill    secrete 

Its   proper  juice,   the   gastric. 
Depending   on   derangement   of 

The   Eighth — the  pneumogastric. 


And  my  own  cutis.   I   know  't   well. 

Is  of  a  sickly  sallow 
(Although  I've  taken  Calomel). 

It's  stained  a  bilious  yellow. 

My  ills.  God  save  the  mark!  are  great. 

And  my  afflictions  legion; 
At  times  I  feel  a  deadly  weight 

In  my  precordial  region. 

And  Phthisis  Pulmonalis,  too, 

Makes  to  me  its  migration; 
For  I've  been  told  that  I.  alas! 

Had  bronchial  respiration. 

But  it's  no  marvel  that  I'm  sick; 

Six  lectures,  sometimes  seven. 
Each  day,  and  then  the  "Quiz"  to  boot 

Five  times  per  week,  good  Heaven! 

And  then  withal  the  deadly  fear 

Of   being   "pitched"   when   I 
Within   the  "Green-Room"  shall  be  asked 

The  wherefore?  and  the  why? 

Therefore   incline   Thy  bounteous   Ear, 

Thou  Lord  divinely  great. 
And  O,  fulfil  the  earnest  pray'r  ,      ,    , 

Of  me.  A   Candidate: 

"Make  our  Professors'  breasts  to  feel 
Some  kindliness  when  they 
Examine  us  poor-  fellows  on 
A  not  far-distant  day. 

"Make  that  they  may  recall  the  time     ; 

When  they  were  students  yet;  '   '• 

Their  own  sad  fears  and  doubts,  good' Lord! 
Let  them  not  then  forget! 

'Make  them  recall  that  we  were  forced 

To  "cram" — and  hence  forgot  .    ■ 

The  details,  the  minutiae. 

Though  maybe  gross  things  not. 

'Let  them  remember  that  it  took 

Them  years  of  study  to 
Learn  all  they  know — and  let   them  look 

On  us  with   friendly  view!" 


THE  VILLAGE  DOCTOR. 

A  Parody  on  the  Village  Blacksmith. 

By  the  Editor. 

Seated  in  his  one-horse  chaise, 

The  village  Doctor  makes  his  rounds; 

The  Doctor,  a  grand  old  man  is  he. 

Whose  weight  is  scant  two  hundred  pounds 

But  when  the  call  for  help  is  made. 
The  Doctor  at  his  post  is  found. 


THE   HOSPITAL   BULLETIN 


13 


lli*  hair  is  white,  thin  and  long, 

His  face  is  full  of  cheer; 
His  brow  is  knit  with  anxious  thought, 

He  knows  no  sense  of  fear; 
lie  stares  disease  full  in  the  face. 

For  life  to  him  is  dear. 

Day  in,  day  out.  from  year  to  year, 

You  sec  him  come  and  go; 
You  see  him  on  some  mission  bent. 

You  hear  his  old  horse  blow; 
He  stops  not  for  Summer's   sun. 

Nor  Winter's  blasts  of  snow. 

The  children  coming  home  from  school 

Greet  him  passing  by; 
They  love  to  cheer  the  grand  old  man. 

Perched  in  his  old  chaise  high; 
As  they  catch  his  kindly  greetings 

They  seem  to  hear  him  sigh. 

On  Sundays  when  he  goes  to  church. 

He  sits  quite  near  the  door; 
He  hears  the  parson  pray  and  preach, 

He  thinks  about  the  poor, 
N'eeding.  perhaps,  his  services, 

And  it  makes  him  sorrow  more. 

He  recalls  the  sick  and  suffering. 

How  on  beds  of  pain  they  lie; 
He  needs  must  give  relief  to  some. 

But  some  are  sure  to  die; 
His  big  heart  fills  with  emotion 

As  tears  drop  from  his  eye. 

Sorrowing,  toiling,  comforting, 

Onward  through  life  he  goes; 
Each  morning  finds  him  at  his  task, 

Which  evening  does  not  close; 
Someone  helped,  others  calling. 

But  night  brings  no  repose. 

Thanks,  thanks  to  thee,  our  dear  old  friend. 

For  the  good  which  thou  hast  done! 
For  all  thy  deeds  of  kindness. 

For  all  the  victories  won; 
May  angel  voices  praise  thee 

Where  angel  songs  are  sung. 


The  Nineteenth  and  Sixth  Annual  Meeting 
<>f  the  General  Alumni  Association  was  held  in 
the  Law  Building  of  the  University  of  Mary- 
land, Tuesday,  February  23,  IQOQ,  at  8.30  o'clock 
P.   M. 

Very  important  business  was  discussed  and 
several  resolutions  of  great  moment  to  the  Uni- 
versity were  introduced.  The  first  order  of  busi- 
ness was  the  adoption  of  resolutions  of  sympathy 
for  our  sister  department,  St.  John's  College. 
Department  of  Arts  and  Sciences,  on  the  loss  of 
McDowell  Hall.  The  resolutions  were  as  fol- 
lows : 


Whereas  we  recognize  in  the  loss  of  this  old 
colonial  building,  the  chief  glory  and  honor  of 
St.  John's  and  one  hallowed  by  over  a  century 
and  a  half  of  association,  an  irreparable  catas- 
trophe to  this  University,  to  the  State  of  Mary- 
land, and  to  the  cause  of  education : 

Resolved  ( 1 ) ,  That  we  extend  to  President 
Fell  and  the  authorities  of  St.  John's  our  warm- 
est sympathies  in  their  misfortune  and  our  earn- 
est hope  that  it  may  lead  many  generous  friends 
to  contribute  so  liberally  that  a  greater  and  more 
glorious  McDowell  Hall,  may  arise  Phoenix  like 
from  the  ashes. 

(2)  That  we  pledge  ourselves  to  do  everything 
in  our  power  to  secure  this  result,  and  hereby  di- 
rect our  Committee  on  Endowment  to  open  a  sub- 
scription list  among  our  alumni  and  the  citizens 
of  Baltimore. 

(3)  That  a  copy  of  these  resolutions  be  sent  t<> 
1  >r.  Fell  and  also  given  to  the  press. 

Dr.  John  C.  Hemmeter  delivered  an  addre^- 
advocating  the  creation  of  a  Board  of  Alumni 
Counsellors.  Although  Dr.  Hemmeter  did  not 
speak  officially  for  the  Board  of  Regents,  still  he 
suggested  that  such  a  proposition  would  receive 
favorable  consideration  by  that  Board.  This 
would  mark  a  distinct  step  forward  by  the  Uni- 
versity-, and  no  doubt  would  be  greatly  appreci- 
ated by  the  alumni.  There  has  and  is  still  a  feel- 
ing that  the  members  of  the  Faculties  of  the  Uni- 
versity do  not  desire  any  outside  interference. 
and  that  the  University  is  a  closed  corporation 
run  for  the  benefit  of  the  professors.  Such  a 
gracious  act  as  the  countenancing  of  a  Hoard  of 
Alumni  Counsellors  would  at  once  dispel  this 
distrust.  A  motion  was  made  by  Dr.  Wilkinson, 
and  amended  by  Dr.  Taneyhill,  that  the  chair  ap- 
point a  Committee  of  Ten  to  consider  the  matter 
and  report  at  the  next  meeting.  This  motion  was 
seconded  by  Dr.  Hynson. 

The  next  order  of  business  was  a  resolution 
equally  as  pregnant  for  the  welfare  of  the  Uni- 
versity as  that  just  mentioned.  This  was  pro- 
posed by  Dr.  Hopkinson,  and  seconded  by  Dr.  N. 
Winslow,  and  was  as  follows : 

Whereas  the  progress  of  the  University  of 
Maryland  appears  to  be  greatly  impeded  and  its 
participation  in  the  great  educational  founda- 
tions prevented  by  the  present  organization  of 
the  governing  body ;  be  it 

Resolved,  That  the  General  Alumni  Associa- 
tion of  the  University  of  Maryland  implores  the 


14 


THE   HOSPITAL  BULLETIN 


Regents  to  take  such  steps  as  will  remedy  the 
existing'  conditions  by  the  election  of  a  paid  Pro- 
vost  or  President,  with  a  governing'  body  inde- 
pendent of  the  teaching  bodies. 

A  motion  was  made  and  passed  that  a  com- 
mittee of  three  be  appointed  by  the  chair  to  re- 
vise the  rules  and  regulations. 

The  following  officers  were  elected  for  the  en- 
suing year:  President,  J.  B.  Thomas,  Ph.  G. ; 
First  Vice-President,  Isaac  Davis,  M.  D.,  D.  D. 
S. ;  Second  Vice-President.  James  E.  Carr,  Jr.. 
LL.  B. ;  Third  Vice-President,  J.  Fred  Adams, 
M.  D.,  St.  John's;  Fourth  Vice-President,  Ran- 
dolph Winslow,  M.  D. ;  Fifth  Vice-President,  J. 
W.  YVestcott,  Phar.  D. ;  Treasurer,  Daniel  Base, 
1'h.  D. ;  Secretary,  Chas.  G.  Sadtler.  M.  D. 

Executive  Committee — Dr.  B.  Merrill  Hopkin- 
son;  L.  W.  Farinholt,  D.  D.  S. ;  II.  P.  Hynson, 
Phar.  D. :  J.  II.  Skeen.  LL.  1'..:  Jacob  Bird,  M. 
D..  St.  John's. 

Endowment  Committee — E.  F.  Cordell,  M.  D. ; 
Judge  Henry  Stock-bridge :  C.  V.  Matthews,  D. 
D.  S. ;  Leroy  Robinson.  Ph.  G. ;  L.  B.  K.  Clag- 
gctt.  St.  John's. 

According  to  a  ruling  of  the  chair,  the  presi- 
dency rotates  among  the  various  departments, 
and  as  Law,  Medicine  and  Pharmacy  have  had  a 
representative  in  the  chair,  the  next  incumbent 
will  be  a  representative  of  Dentistry,  and  two 
years  hence  a  graduate  of  the  Department  of 
Arts  and  Sciences. 


Dr.   Hiram   Woods  was  recently  registered  at 
the  Chalfonte,  Atlantic  City. 


1  )r.  St.  Clair  Spruill  has  returned  from  Atlantic 
City,  where  he  was  recuperating  from  an  attack 

i  if  appendicitis. 


Dr.  Norman  Dudley,  class  of  1901,  of  Church 
Hill,  Md.,  recently  visited  the  Hospital.  Among 
other  recent  visitors  were  Dr.  Rollin  Jefferson. 
Jr.,  of  Tampa.  Fla..  and  Dr.  Byron  \Y.  Eakin, 
class  of  1903,  of  West  Virginia. 


Dr.  Claude  Van  Bibber-,  class  of  1X77.  of  Bal- 
timore, one  of  the  best  known  physicians  in  the 
city,  has  been  seriously  ill  at  his  home,  9  E.  Read 
street,  as  the  result  of  a  fall  several  weeks  ago. 
1  )urinsr  the  last  snow  1  )r.  Van  Bibber  was  called 


out  late  at  night  and  slipped  on  the  ice.  He  paid 
little  or  no  attention  to  the  accident  until  several 
days  later,  when  he  complained  of  severe  pains, 
and  was  forced  to  go  to  bed.  Though  52  years 
of  age.  Dr.  Van  Bibber  is  a  man  of  strong  and 
healthy  physique. 

Dr.  Van  Bibber  married  Miss  Margaret  Co- 
hen, daughter  of  Judge  M.  M.  Cohen,  late  of  the 
Supreme  Bench  of  Louisiana.  They  have  three 
children. 


Mr.  T.  A.  Joyues,  of  2330  Eutaw  place,  an- 
nounces the  engagement  of  his  daughter,  Miss 
Julia  Armistead  Joynes,  to  Dr.  Arthur  Marriott 
Shipley,  of  Baltimore.  The  wedding  will  take 
place  in  June. 

Dr.  Shipley  is  a  native  of  Anne  Arundel 
county,  Md.,  and  took  his  degree  of  medicine 
with  the  class  of  1902,  University  of  Maryland, 
of  which  institution  he  is  now  an.  associate  pro- 
fessor. After  his  graduation  Dr.  Shipley  held 
the  post  of  assistant  surgeon  at  the  University 
Hospital  until  June,  1904,  when  he  was  ap- 
pointed medical  superintendent,  which  position 
he  held  until  June,  1908. 


The  Alpha  Chapter  of  the  Kappa  Sigma  Fra- 
ternity, University  of  Maryland,  received  at  the 
Fraternity  Flouse.  130  West  Lanvale  street,  re- 
cently. The  house  was  decorated  with  smilax 
and  cut  flowers.  After  the  reception  there  was 
a  dance. 


Dr.  Walter  Wickes.  class  of  1900,  and  Mrs. 
Wickes  have  taken  an  apartment  at  the  Wash- 
ington and  will  make  their  permanent  home  in 
Baltimore. 


The  following  of  our  alumni  are  on  the  State 
Board  of  Health  of  Maryland: 

Secretary  and  Executive  Officer  —  Dr.  Mar- 
shall Langton  Price,  class  of  1902,  10  South 
street.  Baltimore. 

Laboratory  Assistant — Dr.  Harry  W.  Stoner, 
class  of  1907,  1826  East  Monument  street.  Bal- 
timore. 

Bacteriologist — Dr.  Wm.  R.  Stokes.  1639 
North  Calvert  street. 


Dr.  John  A.  Tompkins,  class  of  1898,  is  lieu- 
tenant and  surgeon.  Maryland  Naval  Brigade. 


THE    HOSPITAL    BULLETIN 


15 


The  following'  of  our  alumni  arc  county 
health  officers : 

Anne  Arundel — Dr.  James  J.  Murphy,  class  of 
1S96,  of  Annapolis;  First  Precinct,  Fifth  Dis- 
trict, Dr.  II.  Brooke,  Brooklyn,  class  of  1891. 

Baltimore  County — First  District,  Dr.  Arthur 
H.  Mann,  Jr..  class  of  1890,  Catonsville ;  Third 
District.  Dr.  II.  A.  Xaylor,  class  of  1900,  Pikes- 
ville;  Fourth  District,  Dr.  Harry  M.  Slade,  class 
of  1884,  Reisterstown :  Fifth  District,  Dr.  B.  F. 
Price,  class  of  1857,  of  Mt.  Carmel ;  Sixth  Dis- 
trict, Dr.  John  B.  Norris,  class  of  1866,  of  Beck- 
leysville ;  Seventh  District,  Dr.  E.  W.  Heyde, 
class  of  1892,  of  Parkton  ;  Ninth  District,  Dr.  R. 
C.  Massenberg,  of  Towson ;  Eleventh  District, 
Dr.  James  F.  H.  Gorsuch,  class  of  1876,  of  Fork ; 
Twelfth  District,  Dr.  W.  C.  McClannahan,  class 
of  1902,  of  Highlandtown. 

Caroline — Dr.  Enoch  George,  class  of  1872,  of 
Denton. 

Carroll — -Second  District,  Dr.  Luther  Kemp, 
class  of  1887,  Uniontown ;  Sixth  District,  Dr. 
John  F.  B.  Weaver,  class  of  1864,  Manchester; 
Seventh  District,  Dr.  Charles  R.  Foutz,  class  of 
1897,  Westminster;  Eighth  District,  Dr.  Richard 
F.  Richards,  class  of  1897,  of  Hampstead;  Ninth 
District,  Dr.  Edwin  D.  Cronk,  class  of  1884,  of 
Winfield;  Eleventh  District,  Dr.  George  II. 
Brown,  class  of  1864,  of  New  Windsor ;  Twelfth 
District,  Dr.  James  Watt,  class  of  1863,  of  Union 
Bridge ;  Thirteenth  District,  Dr.  W.  F.  Gaver, 
class  of  188—,  of  Mt.  Airy. 

Dorchester — Dr.  Guy  Steele,  class  of  1897,  of 
Cambridge. 

Garrett— Dr.  II.  W.  McComas,  class  of  1888, 
of  Oakland. 

Harford— Dr.  W.  B.  Kirk,  class  of  1893,  of 
Darlington. 

Queen  Anne's — Dr.  A.  E.  Landers,  class  of 
1907,  of  Crumpton. 

Talbot — Dr.  E.  R.  Trippe,  class  of  1862,  of 
Easton. 

Washington — Dr.  J.  E.  Pitsnogle,  class  of 
1889,  of  Hagerstown. 

Wicomico — Dr.  Charles  R.  Truitt,  class  of 
1891,  of  Salisbury. 


The  following  of  our  alumni  are  town  health 
officers : 


Aberdeen — Dr.  Charles  R.  Kriete,  class  of 
1895. 

Brunswick — Dr.  Levin  West,  class  (if  1886. 

Cambridge — Dr.  J.  C.  Travers,  class  of  1895. 

Cumberland — Dr.  George  L.  Carder,  class  of 
1891. 

Easton — Dr.  Philip  L.  Travers.  class  of  1902. 

Frostburg — Dr.  J.  M.  Price,  class  of  1890. 

Kensington — Dr.  Wm.  L.  Lewis,  class  of  1892. 

Laurel— Dr.  W.  F.  Taylor,  class  of  1884. 


Dr.  Marshall  L.  Price,  class  of  1902,  is  a  mem- 
ber of  the  State  Board  of  Health  of  Maryland. 


Dr.  tiny  Steele,  class  of  180,7,  of  Cambridge, 
is  one  of  the  managers  of  the  State  Tuberculosis 
Sanitarium,  located  at  Sabillasville. 


The  following  of  our  alumni  are  members  of 
the  Board  of  Medical  Examiners  of  Maryland: 
Dr.  Plerbert  Harlan,  class  of  1879,  of  Baltimore ; 
Dr.  W.  \Y.  Goldsborough.  class  of  1901,  of 
( ireensboro. 


The  following  of  our  alumni  attended  the  last 
meeting  of  the  Hook  and  Journal  Club,  held  at 
the  Medical  and  Chirurgical  Building:  Dr.  Hi- 
ram Woods.  Dr.  J.  Whitridge  Williams,  Dr.  PI. 
M.  Thomas,  Dr.  William  Royal  Stokes. 


Dr.  W.  1).  Scott,  class  of  1905.  is  vice-presi- 
dent of  the  Baltimore  Alumni  Association  of  the 
Virginia  Military  Institute,  lie  is  also  on  the 
banquet  committee. 


Friday,  February  26.  1909,  Dr.  T.  Chew 
Worthington,  class  of  187(1,  read  a  paper  entitled 
"The  intranasal  frontal  sinus  operation.  The  ac- 
cessibility of  the  sinus  and  the  prognosis  of  the 
operation."  before  the  Section  on  Laryngology 
and  Rhinologv. 


Dr.  William  II.  Welch  was  the  guest  of  honor 
recently  at  a  banquet  tendered  him  by  the  Beta 
Alpha  and  the  Beta  Beta  Chapters  of  the  Nu 
Sigma  Nu  Fraternity  at  the  Belvedere  Hotel. 
The  banquet  was  served  in  the  tearoom  of  the 


16 


THE   HOSPITAL   BULLETIN 


hotel,  and  the  tables  were  resplendent  with  cut 
flowers  and  trailing  asparagus.  Dr.  Harvey 
Gushing  acted  as  toastmaster.  Speeches  were 
made  by  Dr.  John  C.  Hemmeter,  Dr.  J.  M.  T. 
Finney,  Dr.  Samuel  Chew  and  Dr.  II.  M. 
Thomas.  Some  of  the  invited  guests  were  Drs. 
J.  J.  Abel.  Hiram  Woods,  J.  Mason  Hundley, 
Jacob  Bird,  Joseph  Hart,  Jose  L.  Hirsh,  II.  C. 
Davis  and  T.  Harris  Cannon. 


Dr.  Timothy  O.  Heatwole,  class  of  1897,  City 
Councilman  from  the  Twelfth  Ward,  who  re- 
sides at  2003  North  Charles  street,  has  been  con- 
fined in  the  University  Hospital  with  appendicitis. 


The  last  meeting  of  the  Baltimore  County 
Medical  Society  Mas  held  in  the  hall  of  the  Alert 
Engine  Company,  and  was  addressed  by  Dr. 
Hiram  Woods.  Among  those  present  were  the 
following  of  our  alumni:  Drs.  H.  D.  Cox.  Ar- 
lington ;  William  D.  Corse,  Gardenville ;  Hiram 
Woods,  Baltimore;  James  II.  Wilson,  class  of 
[868,  Fowblesburg;  Josiah  S.  Bowen,  Alt.  Wash- 
ington; Harry  G.  Naylor.  Pikesville :  H.  Louis 
Xavlor.  Pikesville;  E.  A.  Jones,  Baltimore 
county;  L.  Gibbons  Smart,  Lutherville :  J.  M. 
Hundley,  Baltimore;  R.  C.  Massenburg,  Towson. 


Dr.  fohn  R.  Winslow  has  returned  from  Rich- 
mond, Va.,  where  he  presented  a  paper  to  the 
American  Laryngological,  Rhinological  and  Otol- 
oerical  Society . 


Dr.  L.  J.  Goldbach  writes  to  Tin-:  Bulletin: 
"My  attention  has  been  called  to  the  fact  that  a 
statement  in  my  article  on  the  ear  polyp  in  The 
Hospital  Bulletin  of  the  January  number,  is 
liable  to  be  misinterpreted,  so  I  respectfully  re- 
c|iiest   space  to  make  matters  clear. 

"The  statement  reads:  'Our  method  of  treat- 
ing the  aural  polyps  at  the  Presbyterian  Eye.  Ear 
and  Throat  Hospital  is  by  means  of  10  per  cent, 
formalin  irrigations  (10  gtts.  to  a  half  tumbler 
of  warm  water).     I  had  no  idea  of  meaning  that 


10  per  cent,  formalin  could  be  used  without  dilu- 
tion:  rather,  one-half  tumbler  of  warm  water 
1  practically  4  oz.j,  to  which  add  10  gtts.  of  a  10 
per  cent,  solution  of  formalin,  this  making  the 
injecting  fluid  about  1-2000.'  " 


At  a  meeting  of  the  Anne  Arundel  County 
Medical  Society,  held  February  9,  1909,  the  fol- 
lowing of  our  alumni  were  elected  to  office  for 
the  ensuing  year :  Vice-President,  J.  Oliver  Pur- 
vis. M.  D. ;  Treasurer,  Frank  H.  Thompson, 
M.  D. ;  Secretary,  Louis  B.  Henkel,  M.  D. ;  Cen- 
sor, J.  S.  Billingslea,  M.  D. :  Delegate  to  the  State 
Faculty,  C.  R.  Winterson,  M.  D. 


At  the  last  meeting  of  the  University  of  Mary- 
land Medical  Association,  held  in  the  amphithe- 
atre of  the  University  Hospital,  Tuesday,  Feb- 
ruary 16,  1909,  at  8.30  P.  M.,  the  program  was 
as  follows : 

1.  The  Gonococcus.  Its  Toxins  and  Paths  of 
Infection — Mr.  W.  F.  Weber,  of  the  Senior 
Class. 

2.  Systematic  Infections  due  to  the  1  ionococcus — 
Dr.   Harry  Adler. 

3.  Treatment  of  Acute  Gonorrhoea — Dr.  Page 
Edmunds. 

4.  Treatment  of  Chronic  Gonorrhoea — Dr.  W.  D. 
Scott. 

5.  The  Treatment  of  Gonorrhoea  in  the  Female 
—Dr.  Flush  W.  Brent. 


The  twenty-third  annual  reunion  and  banquet 
of  the  Princeton  Alumni  Association  was  held 
February  2j,  1909,  at  2  West  Eager  street.  Bal- 
timore. Among  those  present  were  the  follow- 
ing of  our  alumni:  Dr.  Hiram  Woods,  Dr.  Silas 
Baldwin.  Dr.  C.  W.  Mitchell.  Dr.  Hiram  Woods 
was  elected  a  member  of  the  executive  com- 
mittee. 


Dr.  Fell  writes:  "Dr.  Nathan  Winslow — I  am 
very  much  obliged  for  your  very  kind  letter  of 
sympathy   in   our   recent   severe   loss.      In   many 


THE   HOSPITAL   BULLETIN 


1? 


ways  it  is  irreparable,  but  1  hope  that  one  good      Winslow  :     "I  am  very  glad  to  be  able  to  tell  you 
effect  growing-  out  of  it  may  be  a  development      that  my  wish  for  the  appointment  on  the  surgical 


of  a  strong  feeling  for  the  University  of  Mary- 
land, making"  us  of  one  interest  and  of  one  mind. 
The  members  of  the  other  Faculties  have  been 
most  kind  in  the  feeling  they  have  expressed." 


Dr.  Edgar  G.  Ballenger.  class  of  1901,  is  editor 
of  the  Journal-Record  of  Medicine,  published  at 
Atlanta.  Ga. 

Among  our  alumni  subscribers  to  the  annual 
banquet  of  Loyola  College  were  the  following: 
Dr.  Louis  W.  Knight.  Dr.  L.  J.  Goldbach,  Dr.  J. 
J.  Carroll.  Dr.  T.  J.  O'Donnell,  Dr.  F.  A.  Kirby. 
Dr.  Charles  O'Donovan,  Dr.  W.  F.  Schwartz,  Dr. 
E.  F.  Milholland,  Dr.  L.  E.  Neale,  Dr.  M.  A. 
O'Neill. 


In  a  letter  to  Professor  Randolph  Winslow, 
Dr.  T.  Rassy,  class  of  1902,  says,  in  part: 
"Lately  I  received  a  letter  from  my  nephew, 
Jenil  Rassy,  who  is  now  in  the  University.  Jenil 
thinks  that  the  University  of  Maryland  is  ideal, 
and  he  is  sorry  he  did  not  go  there  sooner.  Jenil 
tells  me  that  the  University  has  wonderfully  im- 
proved. I  am  very  glad  and  happy  to  hear  it.  as 
nothing  makes  me  more  delighted  than  to  hear 
of  the  progress  of  the  dear  old  University  of 
Maryland."  He  goes  on  to  ask  of  the  various 
instructors  with  whom  he  was  acquainted,  and 
continues:  "Since  I  left  Baltimore  I  went  to 
Constantinople,  where  I  received  my  Ottoman 
Permit,  and  then  returned  home  to  Syria,  where  I 
practiced  privately  for  about  15  months.  In  Sep- 
tember, 1904,  I  joined  the  Egyptian  Army  as  a 
member  of  the  Medical  Corps,  and  here  I  am  still 
an  officer  in  His  Highness  the  Khedive's  Army." 
He  then  says  he  intends  remaining  in  the  Egypt- 
ian service  for  at  least  five  vears  longer. 


staff  of  our  hospital  has  been  gratified.  The 
Governor's  meeting  was  held  at  a  later  date  than 
I  had  supposed.  I  want  again  to  thank  you  for 
the  valuable  assistance  afforded  me  by  your 
letter." 


The  handsome  residence  of  Dr.  Edward  A. 
Wareham.  class  of  1883.  on  Potomac  avenue. 
Ilagerstown.  was  destroyed  by  fire  Februarv  4, 
1909,  entailing  a  loss  of  $20,000,  partially  cov- 
ered by  insurance.  Dr.  YVareham's  three  chil- 
dren were  compelled  to  flee  from  the  burning 
building  in  their  night  clothes.  The  fire,  which 
started  in  the  attic,  was  thought  to  be  due  to 
crowed  electric  wires. 


Dr.  James  S.  Fox,  class  of  1907,  of  Charleston, 
S.  C,  a  former  house  student  and  ex-resident  in 
the  obstetrical  department,  has  been  appointed  a 
lieutenant  in  the  Medical  Corps  of  the  United 
States  Army.  He  was  one  of  the  14  successful 
out  of  a  total  of  56  candidates  at  the  recent  ex- 
aminations   for   entrance    to    this    branch    of    the 


Dr.  J.  Holmes  Smith  has  been  appointed  sur- 
geon to  the  United  Railway  service  connected 
with  the  University  Hospital. 


Dr.  11.  M.  Fitzhugh,  class  1897,  now  practicing 
his  profession  in  Westminster,  Md.,  with  success, 
has  been  a  recent  visitor  to  the  University  Hos- 
pital. Dr.  Fitzhugh  was  formerly  a  resident  phy- 
sician to  the  Hospital,  and  he  enjoys  his  visits  to 
his  former  haunts. 


Dr.  T.  S.  Latimer,  class  of  1907,  is  now  a  suc- 
Dr.   Arthur  E.   Ewens,  class  of   1904,  of  At-      cess ful  practitioner  in  I  lyattsville.  Md.     Dr.  Lat- 
lantic    City,    N.    J.,    writes    Professor    Randolph      inier  recently  visited  the  Hospital. 


18 


THE   HOSPITAL   BULLETIN 


Dr.  Alexander  D.  McConachie  has  been  ap- 
pointed eye  and  ear  surgeon  to  the  Union  Hos- 
pital of  Cecil  county,  at  Elkton,  Md. 


Dr.  J.  J.  Taylor,  class  of  1908,  of  Madison, 
N.  C. ;  Dr.  John  Bizzill,  class  of  1908,  of  Tampa, 
Fla. :  Dr.  Keavy  Pearlstine,  class  of  1906,  of 
Charleston.  S.  C.  and  Dr.  John  S.  Kerr.  Jr.,  class 
of  1908.  of  Wilmington,  N,  C.  have  been  recent 
visitors  to  the  University  Hospital.  These  recent 
graduates  of  the  University  believe  that  an  occa- 
sional visit  to  nlma  mater  is  beneficial  in  many 
ways. 


The  Bulletin  is  always  glad  to  see  the  alumni 
of  the  University  around  the  Hospital.  It  is  a 
good  sign  when  our  former  students  come  back  to 
the  Hospital  to  freshen  up  their  clinical  work. 


The  final  meeting  of  the  Executive  Council  of 
the  Centennial  Committee  was  held  at  the  resi- 
dence of  Prof.  John  C.  Hemmeter  on  Tuesday, 
March  9.  The  object  of  the  meeting  was  to  audit 
the  accounts  of  the  treasurer.  After  the  paying 
1  if  the  cost  of  publishing  the  Centennial  Volume 
and  the  designing,  casting  and  erection  of  the 
James  Carroll  memorial  tablet,  there  was  reported 
a  small  balance  in  the  Calvert  Bank. 

The  auditing  was  done  by  Dr.  B.  Merrill  Hop- 
kinson.  Dr.  T.  O.  Heatwole  and  Dr.  I.  II.  Davis. 
The  committee  voted  that  the  small  balance 
should  be  left  at  interest  in  the  Calvert  Bank  in 
order  to  defray  expenses  of  sending  the  Cen- 
tennial Volume  to  the  university  libraries  of 
this  country.  Canada,  Europe,  etc. 


Daisy  Yarbrough,  of  Staunton,  Va.,  were  mar- 
ried in  the  First  Presbyterian  Church,  at 
Staunton,  recently.  They  will  reside  at  Maple- 
wood.  X.  J.,  where  the  groom  has  been  prac- 
ticing medicine  for  several  years. 

Tlie  Virginia  papers  described  the  Ranson- 
Yarbrough  wedding,  which  was  celebrated  at 
Staunton,  Ya.,  on  Thursday,  February  4th,  as 
being  one  of  the  most  beautiful  of  the  season. 

The  contracting  parties  were  Miss  Daisie  Yar- 
brough, of  Staunton,  and  Dr.  B.  B.  Ranson,  Jr., 
of  Maplewood,  N.  J.  The  wedding  ceremony 
was  performed  at  the  First  Presbyterian  Church 
at  6  o'clock,  and  the  decorations  were  simple,  but 
most  effective,  being  composed  entirely  of  hand- 
some palms  and  white  candles.  A  brilliant  re- 
ception was  given  at  the  home  of  the  bride,  and 
later  Dr.  and  Mrs.  Ranson  left  on  an  extended 
tour.    They  will  reside  in  Maplewood. 

Dr.  Ranson  graduated  in  the  Medical  Depart- 
ment, class  of  1902.  He  was  a  man  of  great 
popularity,  and  has  since  attained  marked  suc- 
cess in  the  practice  of  his  profession. 


Dr.  F.  Garnett  Cowherd,  class  of  1908,  of 
Mount  Savage,  son  of  Mr.  and  Mrs.  William 
Cowherd,  of  Cumberland,  and  Miss  Amie 
Louise  Perdew,  daughter  of  Prof,  and  Mrs. 
George  M.  Perdew,  were  married  this  evening 
at  the  home  of  the  bride  by  Rev.  William 
Cleveland  Hicks.  Miss  Ruth  Perdew  was 
bridesmaid  and  Mr.  Algernon  Hardy,  of  Wash- 
ington, a  cousin  of  the  groom,  was  best  man. 


DEATHS. 


MARRIAGES. 


Dr.  Harry  T.  Talbott,  class  of  1887,  son  of 
Mr.  and  Mrs.  H.  O.  Talbott,  died  at  his  home 

February   26,    1909,   after  an   illness   of   some 

Dr.  Briscoe  Ranson.  class  of  1902,  son  of  Dr.      weeks,  aged  42.    He  is  survived  by  one  daugh- 
B.    P>.   Ranson.  of     Harpers     Ferry,  and  Miss      ter — Miss    Lillian   Talbott — and    one    sister— 


THE  HOSPITAL  BULLETIN 


19 


Mrs.  John  F.  Buckner,  of  Washington.  Dr. 
Talbott's  wife,  who  was  Miss  Lillian  Hedges, 
of  Frederick,  died  some  years  ago.  His  body 
will  be  interred  in  the  latter  place. 


Dr.  J.  H.  W.  G.  Weedon,  class  of  1864.  one 
of  the  most  widely  known  physicians  of  the 
Eastern  Shore  of  Maryland,  and  once  a  mem- 
ber of  the  Legislature,  died  Wednesday,  Feb- 
ruary 17,  1909,  of  Bright's  disease,  at  the  Uni- 
versity of  Maryland  Hospital.  Dr.  Weedon 
was  74  years  old.  and  lived  at  Church  Hill. 
For  two  weeks  Dr.  Weedon  had  suffered 
acutely  from  Bright's  disease,  and  recently  de- 
cided to  come  to  the  University  Hospital.  Dr. 
Weedon  weakened  steadily,  and  died  about 
1.30  o'clock  in  the  afternoon. 

Dr.  Weedon  ws  born  on  Kent  Island.  Sep- 
tember 1.  1835,  and  was  the  son  of  the  late 
Henry  and  Rebecca  I. egg  Weedon.  He  studied 
medicine  and  was  graduated  from  the  Univer- 
sity of  Marylandj  after  which  he  returned  to 
Kent  Island,  where  he  practiced  and  became 
interested  in  politics.  He  represented  the  Dem- 
ocratic party  in  the  Legislature  of  1882.  In 
1885  he  left  the  island  for  Church  Hill,  where 
he  devoted  most  of  his  time  to  practice.  His 
only  immediate  survivor  is  his  widow,  who 
was  formerly  Miss  Mary  R.  Thompson.  The 
body  will  be  taken  to  Church  Hill  for  inter- 
ment. 


Dr.  Edmund  G.  Waters,  class  of  1853,  OI  Bal- 
timore, 79  years  old,  1711  Madison  avenue, 
died  recently.  He  was  the  son  of  Dr.  Francis 
Waters,  of  the  Methodist  Protestant  Church, 
and  was  born  in  this  city.  Dr.  Waters  studied 
in  the  office  of  Dr.  Nathan  R.  Smith,  and  was 
graduated  from  the  University  of  Maryland  in 
the  class  of  1853.  He  married  the  daughter  of 
Dr.  William  Hitch,  and  he  first  had  an  office 
on  Hollins  street,  where  he  engaged  in  the 
practice  of  his  profession.  When  the  Civil  War 
broke  out  Dr.  Waters  was  appointed  assistant 


surgeon  at  the  Camden  Hospital,  and  served 
there  and  at  Jarvis.  Me  afterwards  became 
professor  of  chemistry  at  the  Baltimore  High 
School,  remaining  there  until  he  moved  to 
Dorchester  county,  near  Cambridge,  in  1868. 
In  1882  he  returned,  and  again  engaged  in  prac- 
tice until  the  breaking  of  his  leg  incapacitated 
him  from  active  work. 


Mrs.  Xorris.  wife  of  Dr.  J.  B.  Norris,  class 
of  1866.,  sanitary  officer  of  the  Sixth  district, 
died  recently  at  her  home,  at  Beckleysville. 
She  is  survived  by  her  husband  and  two  daugh- 
ters. Before  her  marriage  she  was  Miss  Gard- 
ner. 


Dr.  Edmund  Cantwell  Gibbs,  of  Baltimore, 
died  at  his  home,  316  East  North  avenue,  as  the 
result  of  Bright's  disease.  Dr.  Gibbs  was  born 
near  Middletown,  Del.,  on  September  17.  1856 
He  was  the  son  of  the  late  Benjamin  and  Hannah 
Justice  Gibbs,  of  Delaware,  and  descendants,  re- 
spectively, of  early  English  and  Swedish  settlers. 
After  leaving  the  Middletown  Academy,  in  Dela- 
ware, Dr.  Gibbs  took  up  pharmacy.  After  several 
years  of  work  at  this  profession  he  came  to  Balti- 
more and  entered  the  Medical  Department  of  the 
University  of  Maryland.  He  was  graduated  in 
1884. 

In  the  last  year  of  his  collegiate  course  Dr. 
Gibbs  was  resident  student  at  the  University  Hos- 
pital, and  for  several  years  was  surgical  dis- 
pensary assistant.  He  was  a  member  of  the 
Medical  and  Chirurgical  Faculty  of  Maryland 
and  medical  examiner  of  the  Shield  of  Honor. 

Besides  his  wife,  Mrs.  Lulu  C.  Gibbs,  Dr.  Gibbs 
is  survived  by  five  children — Joseph  S.  Gibbs,  of 
Wheeling.  W.  Ya. ;  Isaac  Gibbs,  of  Kent  county; 
Anna  Dale,  Gustavus  J.  and  Catherine  J.  Gibbs. 
The  funeral  services  will  be  held  at  the  late  home 
of  the  deceased  tomorrow  afternoon  at  2  o'clock. 
The  body  will  be  taken  to  Middletown.  Del., 
where  burial  will  be  in  the  family  graveyard  in 
Old  St.  Ann's  Churchyard. 


I  N   PNEUMONIA   the-    inspired    air   should    be   rich    in    oxygen   and    ccm- 
■i[    paratively   cool,    while    the    surface    of    the    body,    especially    the    thorax, 
should  be  kept  warm,  lest,  becoming   chilled,  the  action  of  the  phagocytes 
in  their  battle  with  the  pneumocoeci  be  inhibited. 


(Inflammation's  cAntidote) 

applied  to  the  chest  wall,   front,  sides  and    back,    hot    and  thick,   stimulates  the 
action  of  the  phagocytes  and  often  turns  the  scale  in  favor  of  recovery. 

Croup. —  Instead  of  depending  on  an  emetic  for  quick  action  in 
croup,  the  physician  will  do  well  to  apply  Antiphlogistine  hot  and  thick  from 
ear  to  ear  and  down  over  the  interclavicular  space.  The  results  of  such  treat- 
ment are  usually  prompt  and  gratifying". 

Antiphlogistine  hot  and  thick  is  also  indicated  in  Bronchitis  and  Pleurisy 


The  Denver  Chemical  Mfg.  Co. 


INe-vv  York 


ERTAIN  as  it  is  that  a  single  acting  cause  can  bring 
about  any  one  of  the  several  anomalies  of  menstrua- 
tion, just  so  certain  is  it  that  a  single  remedial  agent 
—  if  properly  administered  —  can  effect  the  relief  of 
any  one  of  those  anomalies. 
<]]  The  singular  efficacy  of  Ergoapiol  (Smith)  in  the 
various  menstrual  irregularities  is  manifestly  due  to  its  prompt 
and   direct   analgesic,  antispasmodic  and  tonic  action  upon   the 
entire  female  reproductive  system. 

^  Ergoapiol  (Smith)  is  of  special,  indeed  extraordinary,  value  in 
such  menstrual  irregularities  as  amenorrhea,  dysmenorrhea, 
menorrhagia  and  metrorrhagia. 

<J  The  creators  of  the  preparation,  the  Martin  H.  Smith 
Company,  of  New  York,  will  send  samples  and  exhaustive 
literature,  post  paid,  to  any  member  of  the  medical  profession. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 

PHICK    Sl.OO     PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University. 
Business  Address,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter. 


VOL.   V 


BALTIMORE,  MD.,  APRIL  15,   1909 


No.  2 


THE  ETHICS  OF  THE  GENERAL  PRAC- 
TITIONER. 

An  Address  delivered  Before  the  University  of 

Maryland  Medical  Association, 

March  16,  1909, 

By  Guy  Steele,  M.  D. 
Of  Cambridge,   Md. 

A  celebrated  divine  once  said  that  the  most 
difficult  part  of  a  sermon  was  the  selection  of  a 
proper  text.  I  must  thank  the  President  of 
this  society  for  saving  me  this  trouble.  When, 
however,  Webster's  is  consulted  for  a  proper 
definition  of  the  word  "Ethics,"  and  it  is  found 
to  mean  "The  science  of  human  duty,"  it 
would  seem  that  he  has  chosen  a  text  almost 
too  comprehensive  for  the  limits  of  a  short 
paper,  even  when  restricted  to  the  "ethics  of 
the  medical  profession."  It  may  not  be  out  of 
place  to  thank  him  for  the  honor  he  has  con- 
ferred upon  me  by  deeming  one  whose  student 
days  are  scarce  twelve  years  behind  him 
worthy  of  presenting  this  subject  to  you,  for  a 
paper  on  this  topic  is  almost  of  itself  a  sermon, 
and  we  naturally  look  up  to  those,  whose  many 
years  of  experience  and  works  have  brought 
them  prominence,  for  instruction  in  morals  and 
duty.  Still,  I  take  it,  whether  young  or  old,  all 
of  us  like  to  preach  on  fitting  occasions,  and 
not  the  least  part  of  the  inspiration  to  effort  is 
the  character  of  the  audience.  My  invitation 
was  to  read  a  paper  before  the  Clinical  Society, 
and  incidentally  I  was  told  that  some  of  the 
students  had  expressed  a  desire  to  be  present. 
Little,  however,  did  I  anticipate  such  a  flatter- 
ing attendance  from  them  when  examination 
time  so  nearly  approached,  and  it  is  evidence  of 
a  most  commendable  spirit  when  they  can 
bring  themselves  to  take  even  an  hour  of  their 
most  valuable  time  from  study  to  devote  to  a 
consideration  of  the  moral  duties  and  responsi- 
bilities which  shall  be  theirs  when  they  shall 
have  passed  through  the  April  ordeal.  Much 
that  I  have  to  say  tonight  will  be  directed  es- 
pecial!}' to  them,  and  if  they  or  their  elders  in 


the  profession  may  in  the  years  to  come  look  back 
upon  this  night  with  the  recollection  that  I 
have  more  forcibly  brought  to  mind  some  of 
the  old  and  half-forgotten  maxims  and  axioms 
that  make  for  a  better  and  purer  professional 
life,  I  will  have  been  more  than  repaid  for  the 
time  I  have  expended  in  the  preparation  of  this 
paper. 

In  discussing  the  ethics  of  the  general  prac- 
titioner towards  his  patient,  I  would  have  you 
remember  that  your  first  and  most  important 
duty  is  to  give  to  those  who  trust  you  the  very 
best  that  is  in  you. 

To  you  young  men,  full  of  enthusiasm  for 
your  new  profession,  and  imbued  with  Utopian 
ideas  of  the  mission  which  you  have  under- 
taken for  the  good  of  mankind,  it  would  seem 
almost  foolish  for  me  to  mention  this  as  the 
first  advice  I  would  offer  you.  But  I  think  I 
can  see  a  smile  of  understanding  flit  across  the 
faces  of  those  who  have  for  some  years  fought 
the  battle  of  life,  and  who  have  had  the  wire 
edge  of  early  ambitions  and  determinations 
blunted  by  contact  with  unappreciative 
patients  and  unworthy  professional  competi- 
tion and  the  daily  incidents  of  a  busy  life.  They 
know  that  it  is  very  easy  to  feel  too  tired,  or  be 
too  busy,  or  have  some  other  engrossing  affair 
in  mind  which  prevents  that  entire  devotion  to 
duty  which  all  admit  is  essential  to  success  in 
medicine.  Half  of  success  in  life  or  in  any  un- 
dertaking is  due  to  a  successful  start;  there- 
fore, let  me  ask  you  to  firmly  determine  on  one 
or  two  fixed  principles,  and  to  stick  to  those 
principles  through  thick  and  thin.  Be  fully  as- 
sured that  no  halfway  devotion  to  your  profes- 
sion will  ever  bring  you  prominence  or  success. 
The  time-worn  phrase  that  "Medicine  is  a 
jealous  mistress"  loses  none  of  its  truth  by  fre- 
quent  repetition.  Recently  I  saw  in  a  promi- 
nent medical  journal  the  advice  given  that  cloc- 
tors  should  take  a  prominent  part  in  politics 
and  bring  themselves  forward  in  other  ways, 
and   that  therebv  in  some  way  unknown  to  me 


22 


THE   HOSPITAL  BULLETIN 


the  glory  of  the  profession  would  be  enhanced, 
and  much  benefit  result  to  the  community.  Far 
be  it  from  me  to  discourage  a  proper  civic 
spirit  and  a  proper  interest  in  public  affairs,  or 
to  advise  an  avoidance  of  any  duty  which  good 
citizenship  imposes  upon  every  honest,  patri- 
otic man,  whatever  his  business  or  profession. 
But  I  take  it  that  no  more  baneful,  no  more 
dangerous  advice  can  be  given  to  our  young 
professional  man  than  this.  You  cannot  be 
successful  in  both  politics  and  medicine,  and 
while  we  can  point  to  one  member  of  our  pro- 
fession in  the  United  States  Senate,  and  to 
some  notable  exceptions  in  our  own  State, 
where  men  of  our  profession  have,  for  a  time, 
abandoned  medicine  and  returned  to  it  to  win 
success,  you  can  rest  assured  that  the  medical 
politician  possesses  little  beyond  a  musty 
diploma  to  remind  the  world  that  he  was  once 
of  our  cult.  So  don't  be  a  halfway  politician 
and  halfway  doctor.  Success  in  either  field 
will  take  all  of  your  best  effort  and  all  of  your 
time. 

What  I  have  said  of  politics  will  apply, 
though  not  quite  so  forcibly,  to  any  other  en- 
grossing business  or  pleasure.  Time  forbids 
me  to  elaborate  this  idea,  and  in  concluding  it 
let  me  say  that  you  cannot  be  a  successful  poli- 
tician, merchant,  sport  or  what  not  and  carry 
medicine  as  a  side  line. 

It  may  seem  useless  to  remind  you  that,  in 
order  to  give  the  best  that  is  in  you,  you  must 
keep  abreast  with  what  is  new  and  best  in  pro- 
fessional literature  and  scientific  progress.  You 
all  have  determined  to  be  students,  and  even 
those  who  pride  themselves  on  having  passed 
through  the  University  without  having  opened 
a  book  have  a  half-formed  desire  to  really 
know  something  beyond  spotting  a  possible  ex- 
amination question,  and  when  once  examina- 
tions are  over,  and  they  have  reluctantly  with- 
drawn themselves  from  the  delights  of  the  city 
by  gaslight  for  the  pine  woods  and  mountain 
trail,  they  will  burn  the  midnight  oil  and 
browse  diligently  through  their  musty  tomes. 
May  I  tell  you  that  nothing  is  harder  than  to 
find  time  for  study.  Many  of  us,  even  though 
city  men,  with  the  best  and  latest  literature  at 
our  elbows,  are  ashamed  to  think  how  thor- 
oughly we  abhor  the  sight  of  a  medical  book 
or  magazine,  and  how  easily  we  can  persuade 
ourselves  that  we  are  too  tired  and  stale,  and 


so  engrossed  during  the  day  with  scenes  of 
sickness  and  suffering  that  we  must  have  our 
brief  hours  of  release  from  duty  for  recreation. 
We  do  need  our  hours  of  relaxation  and  rest 
and  our  too  infrequent  holidays,  and  they  are 
absolutely  essential  to  good  health  and  good 
work.  Don't,  however,  confuse  the  words  rest 
and  relaxation  with  sloth  and  idleness,  and 
don't  think  your  professional  work  completed 
when  your  round  of  daily  visits  is  done.  In- 
deed, if  you  would  know  medicine  you  must 
woo  your  mistress  in  the  small  hours  of  the 
night,  and  in  many  of  the  leisure  moments  that 
the  day  may  bring  you. 

Much  has  been  spoken  of  the  man  who  prac- 
tices by  common  sense,  and  whose  school  has 
been  that  of  observation  and  hard  experience. 
A  most  worthy  brother  he  is  at  times,  and 
many  are  his  friends  and  wonderful  his  suc- 
cess. But  if  the  science  of  medicine  is  to  ad- 
vance, more  is  required  for  progress  than  mere 
common  sense,  and  observation  untrained  and 
experience  undirected  and  unguided  by  the  ob- 
servation and  experience  of  others  will  rarely 
discover  a  new  bacillus  or  elaborate  a  side 
chain  theory.  So,  to  be  truly  ethical  in  the 
duty  you  owe  to  give  the  best  that  is  in  you, 
you  should  be  reading  men.  Take  one  or  more 
of  the  medical  journals.  Buy  for  reference  the 
latest  and  best  text-books.  Make  the  opportu- 
nity to  read  the  daily  papers  and  something  of 
current  literature.  A  well-rounded  man  can 
afford  to  do  nothing  less.  Besides  the  infor- 
mation you  obtain,  it  pays  in  the  respect  of  the 
community  to  have  the  reputation  of  being 
posted  in  your  profession.  Often  the  country 
man  simply  hasn't  time  at  home  to  read.  A 
busy  life,  with  its  miles  upon  miles  of  dusty 
roads  to  travel,  precludes  all  chance  for  the 
easy  chair.  Then  cultivate  the  habit  of  reading 
while  driving.  Many  are  the  useful  and  happy 
hours  I  have  spent  in  my  carriage  with  my 
journals  and  magazines.  I  am  frank  to  say 
that,  but  for  this  habit,  I  never  could  have 
found  time  for  one-half  of  the  reading  I  have 
done.  Last  year  I  was  somewhat  amused 
when  a  most  worth}',  well-educated  and  well- 
posted  man  summed  up  his  opinion  of  another 
by  saying  that  he  was  one  of  those  who  read 
magazines  in  his  carriage.  If  I  mistake  not, 
this  indictment  was  brought  against  the  late 
Dr.   Miltenberger,  who  as  a  young  and  busy 


THE  HOSPITAL  BULLETIN 


23 


man  was  forced  to  form  this  habit,  and  I  could 
but  think  that,  could  I  die  with  half  the  honor 
and  respect  and  love  that  were  his,  I  could 
plead  guilty  to  even  this  mark  of  devotion  to 
my  profession  and  desire  to  advance  in  it. 

Would  you  be  ethical  in  giving  the  best  that 
is  in  you  to  your  patients,  you  must  give  un- 
grudgingly of  your  time.  This  may  again  seem 
a  useless  piece  of  advice,  and  yet  almost  all  of 
us  are  familiar  with  the  man  whose  motto  is 
"Veni,  Vidi,  Vici" — "I  came,  I  saw,  I  con- 
quered." This  intuitive  diagnostician  is  by  no 
means  a  myth.  The  man  who  comes  in  a  rush 
and  goes  in  a  rush,  and  who,  with  pencil  in  one 
hand  and  prescription  pad  in  the  other,  feels 
the  pulse  while  the  thermometer  is  under  the 
tongue ;  who  sees  at  a  glance,  without  neces- 
sity of  personal  or  family  history  or  of  physical 
examination,  just  what  is  the  matter,  and  who, 
giving  four  or  five  prescriptions,  rushes  out, 
trusting  that  something  in  his  shotgun  therapy 
may  hit  the  enemy.  Perhaps  the  next  day  he 
prescribes  four  or  five  more  remedies  or  combi- 
nation of  remedies,  and  should  the  patient  be- 
gin to  improve,  prides  himself  that  he  has  made 
and  confirmed  a  diagnosis  by  his  experimental 
therapy.  Is  it  necessary  for  me  to  say  that  no 
ethical  man  with  any  regard  for  the  rights  of 
his  patients  and  his  obligation  to  his  profession 
can  really  practice  medicine  in  this  manner? 
The  plea  that  you  are  too  busy  to  give  the 
proper  time  to  your  cases  is  no  justification  for 
your  neglect.  Anything  less  than  a  careful  in- 
quiry into  family  and  personal  history,  fol- 
lowed by  a  painstaking  and  thorough  physical 
examination,  is  unjust  to  your  patient  and  un- 
just to  yourself.  No  ethical  man  can  give  the 
best  that  is  in  him  by  doing  less  than  this.  If 
you  haven't  the  time  to  do  your  work  thor- 
oughly, make  a  clean  breast  of  the  matter  and 
take  fewer  cases.  But  you  will  say  that  a  man, 
even  in  large  practice,  cannot  afford  to  give 
any  of  it  up.  He  needs  every  dollar  that  hon- 
estly comes  his  way,  and  to  say  that  he  hasn't 
time  for  his  work  is  only  another  way  of  throw- 
ing practice  into  the  hands  of  a  rival.  This  is, 
indeed,  a  proposition  hard  to  solve,  as  most  of 
us  do  need  every  dollar  that  honestly  comes 
our  way;  but  if  our  work  is  only  half  done,  if 
we  have  neglected  some  important  point  in  diag- 
nosis, and  thereby  omitted  some  equally  important 
measure  in  treatment,  have  our  dollars  been 
honestly  earned?     Let  us  start  out  with  and 


carry  in  mind  this  axiom  of  a  truly  ethical  life, 
that  success  in  medicine  cannot  be  measured 
by  commercial  success ;  that,  while  no  sensible 
man  can  neglect  the  business  side  of  his  voca- 
tion, or  refuse  to  demand  and  collect  just  com- 
pensation for  his  service,  such  compensation 
cannot  be  measured  in  dollars  and  cents  alone ; 
that  a  good  conscience  and  whole-souled  devo- 
tion to  duty,  giving  ungrudgingly  of  the  very 
best  that  is  in  you  to  those  that  have  confided 
in  you,  will  be  your  very  best  asset  when  the 
final  account  is  made  up. 

May  I  impress  the  fact  upon  you  that  an  eth- 
ical man,  with  a  just  appreciation  of  his  duty 
to  his  patients,  can  never  be  a  vendor  of  patent 
or  unofficial  medicines.  Indeed,  I  would  be 
lacking  in  my  duty  if,  with  the  opportunity  this 
paper  offers  me,  I  did  not,  from  the  standpoint 
of  experience,  impress  upon  you  with  all  of  the 
force  at  my  command  the  necessity  of  being 
wary  of  the  detail  man  and  the  alluring  adver- 
tising literature  with  which  your  mail  will  be 
flooded.  You  will  scarcely  have  opened  your 
office,  and  be  waiting  with  what  patience  you 
can  command  that  rush  of  the  halt,  the  lame 
and  the  blind  to  which  you  feel  that  your  tal- 
ents entitle  you,  before  the  suave  detail  man, 
having  heard  of  the  new  field,  puts  in  his  ap- 
pearance. What  you  lack  in  therapeutic  ex- 
perience he  can  supply  you  by  drawing  liber- 
ally on  the  experience  of  others  who  have 
worked  little  less  than  miracles  in  an  adjoining 
town  by  the  use.  of  his  pills  and  potions,  his 
elixirs  and  tinctures.  You  will  find  him  smooth 
and  oily,  placid  and  plausible.  He  knows  his 
story  well,  and  even  by  his  much  speaking  can 
almost  persuade  you  that  what  you  knew,  or 
thought  you  knew,  or  what  you  had  recently 
been  taught,  were  all  out  of  date ;  that  by  some 
stroke  of  genius  the  chemist  of  his  house  had 
discovered  some  way  by  which  compatibles 
would  combine  with  incompatibles  into  the  for- 
mation of  a  new  and  staple  mixture,  possessing 
all  of  the  virtues  and  none  of  the  defects  of  its 
original  constituents,  rendering  chloral  as 
soothing  as  the  strings  of  a  lute  and  as  harm- 
less as  the  cooing  of  a  dove,  extracting  from 
cod-liver  oil  every  disagreeable  feature  and 
leaving  nothing  but  its  supposed  virtues  be- 
hind. He  will  show  you  the  short  road  to  for- 
tune and  success.  Treat  him  kindly;  the  ethical 
man  should  not  be  rude,  and  brusqueness  is 
not  a  sign  of  Roman  honesty  or  virtue.    Be  as- 


24 


THE    HOSPITAL   BULLETIN 


Sured  he  feels  his  position  keenly,  and  is  dread- 
ing the  catechism  which  will  sooner  or  later 
display  his  ignorance  of  everything  but  the 
story  that  has  been  drilled  into  him  like  a 
parrot. 

There  has  been  no  greater  shame  in  our  pro- 
fession than  the  influence  these  men  and  their 
houses  have  exercised,  and  incidentally  the  in- 
dorsements and  recommendations  that 
thoughtless  men  have  furnished  them.  The 
blame  is  all  ours,  and  we  cannot  shun  it.  We 
pride  ourselves  on  our  scientific  attainments ; 
that  we  take  nothing  for  granted ;  and,  now 
that  the  age  of  empiricism  has  passed,  we  ac- 
cept nothing  that  does  not  bear  the  stamp  of 
scientific  approval.  And  yet,  before  the  cam- 
paign of  the  American  Medical  Association  and 
the  revelations  of  Collier's  and  the  Ladies' 
1  [•mie  Journal,  we  accepted  our  treatment  from 
the  hands  of  the  manufacturing  houses,  and 
dosed  our  patients  with  nostrums  about  which 
we  knew  nothing  except  the  statements  of 
those  whose  sole  purpose  it  was  to  sell.  There 
are  few  of  us  who  have  been  many  years  in 
practice  to  whom  a  blush  of  shame  does  not 
come  at  the  recollection  of  our  gullibility  and 
our  guilty  innocence.  Can  any  man  deem  it 
ethical  to  give  even  to  a  good  dog  something 
about  which  he  was  totally  ignorant?  And  yet 
this  is  just  what  we  were  doing.  A  short  time 
ago  a  particularly  shrewd  detail  man  was  dis- 
cussing this  very  point  with  me,  and  claiming 
that,  as  the  formula  was  now  required  by  law 
to  be  printed  in  each  bottle  and  package,  this 
most  formidable  objection  could  not  now  hold 
good.  Handing  me  a  bottle  of  his  patent  cure- 
all,  he  glibly  called  my  attention  to  the  six  or 
seven  ingredients,  with  the  amount  of  each 
contained  in  the  fluid  ounce.  Among  other 
potent  quantities  I  can  recall  1-48  gr.  of  mor- 
phia and  1-240  gr.  of  strychnia.  The  dose  was 
a  teaspoonful  three  times  a  day.  Any  man  can 
imagine  the  more  than  homeopathic  effect  of 
1-4S  gr.  of  morphia  divided  into  eight  doses. 
These  well-known  and  well-tried  drugs  were 
not.  however,  the  life  of  the  nostrum,  and  pres- 
ently we  came  to  the  twenty  minims  to  the 
fluid  ounce  of  the  fluid  extract  of  the  drug  from 
which  the  remedy  derived  its  name.  Something 
I  had  never  heard  of.  Something  unlisted  in 
the  U.  S.  P.  Something  discovered  and  owned 
and  controlled  by  this  house  alone.    As  my  ig- 


norance became  more  apparent  his  eloquence 
increased,  and  I  have  no  doubt  that  a  few  years 
ago,  before  my  moral  conscience  had  become 
aroused  to  the  therapeutic  sin  of  prescribing 
something  whose  botanical  family,  whose 
chemical  formula,  and  even  whose  physiologi- 
cal effects  were  totally  unknown  to  me,  I  would 
gladly  have  accepted  a  sample  and  would  have 
tried  it  on  some  poor  soul  too  poor  to  pay 
for  a  prescription.  It  is  nothing  short  of  a 
shame  to  think  of  what  we  have  done  in  this 
line.  The  sin  has  been  one  of  carelessness  and 
laziness  rather  than  of  ignorance.  Here  we 
had  ready  to  hand  some  remedy,  beautiful  to 
the  eye,  palatable  to  the  tongue ;  then  why  take 
the  time  and  trouble  to  bother  about  construct- 
ing a  formula  of  our  own  when  someone  else 
of  equal  experience  had  constructed  one  for 
us?  I  am  ready  to  thank  God  that  most  of 
these  nostrums  are  as  harmless  as  they  are 
beautiful,  and,  while  I  may  not  have  done  good, 
I  rarely  did  harm  by  their  use.  I  am  not  dis- 
cussing the  opium  and  cocaine  laden  classes.  I 
wish  to  emphasize  incalculable  harm  that  must 
result  to  the  physician  himself  who  allows 
someone  to  do  his  thinking  for  him.  I  am  also 
referring  to  the  attitude  of  the  ethical  man  to 
his  patient,  and  beg  to  ask  if  we  are  doing  even 
part  of  our  duty  when  we  are  doing  no  harm. 
Allow  me  to  conclude  this  topic  by  asking  you 
to  spend  an  hour  some  day  in  casually  glancing 
over  (a  deep  study  would  fully  repay  you)  the 
pages  of  the  U.  S.  P.,  or  a  list  of  the  remedies 
that  have  in  one  year  received  the  sanction  of 
the  Council  on  Pharmacy  of  American  Medical 
Association.  If  you  don't  find  enough  drugs 
and  combinations  to  meet  every  case  and  every 
conceivable  situation,  you  had  better  desert 
practice  and  exploit  some  wonderful  cure-all 
as  a  detail  man. 

If  we,  as  physicians,  had  nothing  but  our 
duty  to  our  patients  to  consider,  and  inciden- 
tally our  own  profit  and  glory,  the  practice  of 
medicine  would  soon  degenerate  into  a  mere 
trade.  I  may  even  say  that,  had  we  nothing 
but  the  promptings  of  our  consciences  to  keep 
us  in  the  straight  and  narrow  path,  if  we  had 
nothing  but  the  knowledge  of  work  well  done, 
and  if  the  desire  and  determination  to  give  the 
best  that  is  in  us  were  our  only  incentives  to  an 
ethical  life,  the  profession  would  be  so  beset 
by  the  temptations  of  commercialism,  and  the 


THE   HOSPITAL  BULLETIN 


25 


notoriety  and  prominence  which  commercial 
success  brings,  that  the  halls  of  Esculapius 
would  soon  need  a  scouring  and  purging  great- 
er than  Hercules  gave  the  Augean  stables.  De- 
spite the  high  incentive  to  all  that  is  best  and 
purest  in  life  which  our  noblest  of  callings 
should  beget  in  us,  physicians  are  only  human, 
and  human  weakness,  like  disease,  is  no  re- 
specter of  persons  or  of  callings.  It  may  have 
been  that  the  medical  fathers,  with  a  knowl- 
edge of  the  temptations  to  which  they  were 
subjected,  and  a  desire  to  save  others  from  the 
pitfalls  which  beset  their  paths,  were  imbued 
with  a  determination  to  place  their  profession 
on  a  higher  plane  than  others ;  or  it  may  have 
been  the  natural  evolution  which  inevitably  re- 
sulted from  and  followed  the  promptings  of 
man  to  help  his  fellow-man,  to  devote  himself 
to  the  relief  of  pain  and  sickness,  to  sacrifice 
his  comfort  and  ease  and  almost  every  pleasure 
in  order  that  others  might  have  ease  of  body 
and  peace  of  mind  and  soul,  which  from  the 
earliest  days  have  placed  medicine  as  a  profes- 
sion apart,  and  have  imposed  upon  those  who 
have  entered  its  ranks  certain  standards  of  con- 
duct and  insisted  on  certain  ethical  relations 
which  have  lifted  it  above  mere  questions  of 
gain  and  the  vain  acquisition  of  renown.  We 
have  been  taught  that  Hippocrates  himself  was 
great  not  only  as  a  physician,  but  greater  still 
as  an  ethical  teacher  who  has  left  with  us  cer- 
tain maxims  and  proverbs  which,  though 
handed  down  through  the  ages,  have  lost  none 
of  their  truth  and  none  of  their  spotless  moral- 
ity. Even  in  the  Middle  Ages,  when  learning, 
not  to  say  science,  had  sunk  into  such  an  abyss 
of  ignorance  that  the  ability  to  write  one's 
name  lifted  one  into  the  ranks  of  the  educated, 
when  human  ills  were  relieved  more  often 
with  the  sword  than  with  the  scalpel,  the  leech 
was  a  man  apart.  His  education,  his  scientific 
investigations,  and  even  his  supposed  commu- 
nion and  partnership  with  the  evil  one,  placed 
his  on  a  pedestal  above  other  professional  call- 
ings. Then,  as  now,  though  men  might  scoff 
at  our  profession  of  superior  knowledge  and 
skill,  when  "pallida  mors"  stalked  abroad  or 
knocked  at  the  hovels  of  the  poor  or  palaces  of 
the  rich,  all  arose  to  call  us  blessed.  It  has 
been  often  said  that,  could  a  medical  man  live 
up  to  the  ethical  standards  of  his  profession, 
his  chances  without  creed  or  priest  would  not 


be  small  at  the  last  great  day.  But  with  all  of 
our  high  ideals  we  are  only  mortal,  and  we 
know  and  have  sorrowed  at  the  fact  that  many 
of  our  ethical  standards  are  not  lived  up  to,  and 
that  the  Hippocratic  law  is  frequently  more 
honored  in  the  breach  than  in  the  observance. 

We  have  in  every  community  where  one  or 
two  are  gathered  together  in  the  name  of  medi- 
cine the  man  who  is  everything  to  your  face 
and  everything  else  behind  your  back;  who 
damns  by  faint  praise ;  who  sympathizes  with 
you  in  your  sorrows  and  trials,  who  visits  the 
family  of  the  patient  you  have  lost  to  assure 
them  of  your  skill  and  to  insist  that  everything 

was  done  that  could  have  been  done,  "but" 

and  that  one  harmless  little  conjunction,  mean- 
ing nothing  in  itself,  is  more  eloquent  than  a 
thousand  terrible  adjectives  or  burning,  blis- 
tering adverbs  or  participles.  So  many  things 
can  be  said  by  the  pious  uplifting  of  the  eyes, 
the  sanctimonious  upturning  of  the  palms.  He 
would  not  for  the  world  leave  a  doubt  in  the 
minds  of  your  people,  and,  no  matter  what  in 
his  inmost  heart  he  thinks  of  your  mistakes 
(from  his  standpoint),  it  is  not  his  place  to  in- 
jure a  brother,  but,  alas!  he  is  not  responsible 
for  the  unguarded  tongues  of  his  friends,  and 
he  usually  sees  that  they  do  his  work  well  for 
him.  Often  it  is  "if  I  could  only  have  reached 
him  earlier,"  which,  being  interpreted,  means 
a  miracle  would  have  been  wrought.  Almost 
every  community  has  its  miracle  worker,  its 
medical  resurrectionist.  His  cases  are  always 
a  little  worse  than  others,  his  victories  a  little 
more  wonderful.  Where  you  have  a  bronchitis, 
he  has  a  desperate  pneumonia,  your  transitory 
albuminuria  is  with  him  acute  Bright's,  and 
hopeless  cases  follow  him  to  undo  him,  only 
to  meet  defeat  at  his  skillful  hands.  You  hear 
that  Mr.  A.  is  desperately  ill  with  pneumonia 
on  Monday,  and  on  Friday  you  meet  him  on 
the  street,  looking  hale  and  hearty,  firmly  be- 
lieving that,  had  Dr.  X.  been  one  hour  later  in 
reaching  him,  he  would  ere  this  have  been  gath- 
ered to  his  fathers.  Should  you  mildly  suggest 
that  some  error  in  diagnosis  might  have  been 
made,  that  even  the  best  of  us  at  times  go 
wrong,  and  that  resolution  in  true  pneumonia 
could  hardly  be  expected  in  four  days,  you  will 
find  that  he  has  been  prepared  for  you,  feeling 
that  Dr.  X.  has  used  some  potent  remedy  as 
yet  unknown  to  you  and  his  less  skillful  breth- 


26 


THE   HOSPITAL  BULLETIN 


ren,  and  firmly  convinced  that  your  suspicions 
of  his  case  are  based  upon  your  ignorance  or 
your  jealousy  of  poor  Dr.  X.,  who  was  not 
there  to  defend  himself,  who  had  always  spoken 
so  kindly  of  you,  and  had  uttered  nothing 
worse  than  the  harmless  little  conjunction 
"but" 

A  little  bragging  is  not  a  sin,  and  indeed  is 
usually  harmless,  and  in  the  long  run  reacts  on 
the  miracle  worker.  But  the  ethical  man  does 
frequently  suffer  from  it,  and  it  is  a  fact,  ab- 
surd as  it  may  seem,  that  the  average  man  or 
woman  would  much  prefer  to  be  considered  at 
death's  door  about  three-fifths  of  the  time — in- 
deed, almost  a  walking  Lazarus — than  to  be 
deemed  the  picture  and  personification  of  vig- 
orous health.  Dr.  X.  knows  this,  and  plays 
upon  the  credulity  of  his  patients.  He  fright- 
ens them  to  death's  door,  works  a  miracle,  and 
has  tied  them  to  himself  forever.  We  all  have 
suffered  from  this,  and  will  continue  to  do  so 
until  the  little  grain  of  truth  has  grown  from 
the  tiny  mustard  seed  to  the  vigorous  bush. 
Dr.  X.,  with  his  faults,  has  his  virtues.  He  as- 
pires to  be  the  busiest  man,  the  richest  man, 
the  most  popular  man  in  his  community.  xA.ll 
of  these  ambitions,  if  properly  guided,  are 
laudable,  and,  indeed,  while  enhancing  his 
power  and  prestige,  may  be  redounding  to  the 
good  of  his  people,  for  a  man  to  be  the  busiest 
and  most  popular  man  in  his  profession  must 
usually  be  the  best  posted,  the  most  highly  ed- 
ucated, the  hardest  working  man,  not  only  for 
himself,  but  for  those  he  serves.  So,  while  we 
may  smile  at  Dr.  X.  and  his  big  ways,  we  may 
love  him  for  his  virtues  and  forgive  his  small 
faults. 

But  for  the  man  who  deliberately  goes  to 
work  to  undermine  another;  who  takes  advant- 
age of  some  temporary  absence  of  the  regular 
physician  to  ingratiate  himself ;  who,  appre- 
ciating the  fact  that  people  worried  nearly  to 
death  by  the  illness  of  a  loved  one,  will  forget 
every  obligation  and  desert  every  old  friend  in 
the  hope  that  the  new  one  may  offer  some  en- 
couragement or  extend  some  hope,  is  ready  for 
these  emergencies.  He  carries  satchels  full  of 
hope  for  all  cases  and  occasions.  He  prescribes 
it  liberally,  diluted,  however,  to  the  point  of  de- 
spair because  he  was  called  in  an  hour  too  late, 
or  because  the  case  had  already  been  damaged 
beyond  his  power  of  repair.     This  gentleman 


advances  not  only  by  his  own  deceit,  but  uses 
the  power  of  church,  of  politics,  of  family  influ- 
ence and  social  opportunity,  to  lift  himself 
along.  Verily  he  has  his  reward,  but  it  is  not 
in  peace  of  mind,  not  in  the  honor  and  respect 
of  his  community,  but  the  contempt  of  every 
honest  man,  be  he  of  the  profession  or  laity. 
Not  the  least  of  the  perplexing  questions  which 
beset  the  man  who  is  trying  to  lead  an  ethical 
life  is  his  duty  in  his  relation  as  consultant.  In- 
deed, there  is  scarcely  a  situation  in  profes- 
sional life  that  at  times  presents  more  embar- 
rassing possibilities,  or  calls  for  the  exercise  of 
more  tact.  It  is  a  pleasure  to  be  able  to  bear 
witness  to  the  ability  of  the  man  who  has  called 
you  to  his  aid,  to  assure  the  family  that  every- 
thing has  been  done  that  care  in  diagnosis  and 
skill  in  treatment  could  demand.  But  what  of 
the  cases  where  gross  carelessness  or  blind  ig- 
norance have  hastened  what  might  easily  have 
been  delayed  or  averted?  There  is  only  one 
way  here,  only  one  duty.  Treat  the  man  as  his 
carelessness  or  his  ignorance  deserves.  Again, 
you  are  called  in  consultation  with  a  thoroughly 
good  man  who  has  given  ungrudgingly  of  the 
best  that  is  in  him.  Perhaps  your  superior  skill 
in  certain  lines,  perhaps  your  superior  opportu- 
nity to  observe  a  certain  line  of  cases,  have 
taught  you  something  that  he  has  not  had  the 
chance  to  learn.  As  before  it  was  your  duty  to 
expose  the  careless  ignorance  of  one,  now  it  is 
your  place  to  so  give  your  opinion  and  explain 
your  position  that  no  possible  reflection  can  be 
cast  upon  the  other.  Don't  approach  a  consul- 
tation with  the  manner  of  a  priest  of  Delphi. 
Don't  pose  as  the  fountain  of  all  wisdom  and  of 
all  experience.  Indeed,  in  this  work  you  will 
be  surprised  how  often  you  will  learn  from  him 
you  are  called  upon  to  assist.  He  has  seen  the 
case  for  days,  where  you  can  spend  but  minutes 
with  it.  It  is  his  part  to  bear  the  blame,  yours 
to  share  his  fame  should  success  crown  your 
combined  efforts. 

Frequently  you  will  be  called  upon  when  a 
resort  to  surgery  is  demanded — not  so  much  to 
perform  the  operation  as  to  give  your  opinion 
as  to  the  advisability  of  a  certain  line  of  pro- 
cedure. Having  determined  what  is  to  be  done, 
don't  assume  the  place  of  prominence.  You 
have  little  by  way  of  reputation  to  gain  by 
performing  an  operation  that  you  were  known 
to  be  competent  to  perform  or  you  would  never 


THE   HOSPITAL   BULLETIN 


27 


have  been  called.  Let  him  do  the  work  with 
your  assistance  and  advice.  In  this  way  you 
will  have  gained  a  fast  friend  for  future  consul- 
tations, and  you  will  have  enshrined  him  in  the 
esteem  and  confidence  of  his  people.  Therefore, 
help  him  and  uplift  and  bear  witness  to  his 
worth,  and  don't  humiliate  him  by  your  airs 
and  assumed  superiority. 

As  a  last  word,  don't  consult  with  an  un- 
worthy man,  for  be  assured  that  your  reputa- 
tion is  worth  more  to  you  than  any  consulta- 
tion fee,  however  badly  you  may  think  you 
need  it. 

The  question  of  fees  is  one  that  must  be  con- 
sidered. We  hate  to  think  of  the  combination 
of  medicine  and  money,  and  our  patients  abhor 
it  even  more.  The  days  once  were  when  only  the 
sons  of  the  rich  sought  the  liberal  professions. 
It  was  thought  unworthy  in  the  days  of  the  dim 
ages  for  a  pupil  of  Esculapius  to  charge  for  his 
services.  Any  remuneration  that  came  to  him  was 
an  offering  of  gratitude — indeed  an  honorarium 
which  might  be  tendered  or  withheld  at  the  will 
of  the  patient.  A  truly  noble  conception  this, 
that  the  good  we  offered  was  beyond  a  mere 
question  of  price.  Equally  comforting  was  the 
belief  that  the  ill  which  resulted  despite  our  best 
efforts  was  no  reflection  on  our  skill,  but  an  evi- 
dence of  the  wrath  of  the  Gods.  Would  that  we 
were  as  near  Olympus  now  as  then,  and  that  the 
Gods  walked  with  men  to  reward  the  worthy  and 
punish  the  unjust.  Would  also  that  the  manners 
and  costumes  and  climate  of  Ancient  Greece  were 
still  with  us,  so  that  man  need  take  little  heed  of 
raiment  beyond  a  robe  and  sandals ;  that  he  re- 
quired no  expensive  outlay  for  instruments,  no 
intricate  electric  outfit,  and  no  automobile.  What 
a  life  ours  would  be  if  now  as  then  our  grateful 
patients  sought  us,  and  we  passed  our  many 
hours  of  leisure  in  eloquent  discussion  or  in  lazy 
lounging  amid  the  leafy  groves  or  shaded  por- 
ticos of  the  temples !  But  the  times  have 
changed,  and  we  have  changed  with  them,  and 
abhor  as  we  will  the  combination  of  medicine 
and  money,  we  are  forced  to  take  thought  of  the 
morrow  and  to  spend  many,  many  anxious  mo- 
ments in  this  thought  and  in  trying  to  evolve 
ways  and  means  by  which  a  balance  can  be  main- 
tained between  the  honoraria  of  patients,  both 
grateful  and  ungrateful,  and  the  claims  of  per- 
sistent creditors.  Perhaps  it  is  best  thus,  as  the 
average  man  needs  some  incentive  to  good  work 


beyond  the  acquisition  of  honor  and  glory.  An 
axiom  in  the  question  of  fees  is  this,  that  in  order 
to  be  respected  we  must  respect  ourselves,  and 
no  one  can  respect  himself  unless  he  holds  his 
calling  above  a  trade  and  bases  his  charges  upon 
this  feeling  of  respect  for  himself  and  his  pro- 
fession. This  axiom  should  be  held  in  mind  in 
arranging  any  fee  table,  and  should  be  insisted 
upon  in  our  settlements  with  those  who  think  a 
doctor's  bill  should  be  discounted  from  one- 
quarter  to  one-half.  I  have  often  wondered  how 
this  right  to  a  discount  in  a  doctor's  bill  ever  got 
such  a  firm  hold  in  the  public  mind.  Perhaps  the 
city  man  cannot  appreciate  this  fact  like  his 
country  brother.  The  poor,  honest  old  farmer, 
part  of  the  bone  and  sinew  of  the  land,  expects 
the  highest  cash  price  for  everything  that  he  sells. 
If  anybody  has  ever  heard  of  one  who  when  ten 
barrels  of  corn  at  $3.50  per  barrel  comes  to  $35, 
offering  to  take  $25  for  his  bill,  he  should  corral 
and  cage  this  rara  avis.  But  hundreds  of  us 
from  the  rural  districts  have  been  deemed  mean 
and  close-fisted  and  extortionate  because  we 
gently  insist  that  $35  worth  of  professional  serv- 
ices rendered  are  worth  $35  and  not  $25. 

This  is  largely  our  own  fault,  for  so  many  of 
us  present  a  bill  in  one  hand  and  an  apology  in 
the  other.  We  collect  our  bills  not  as  if  they 
were  our  just  dues,  but  with  a  half-hearted  in- 
sistence, inducing  our  debtor  to  believe  that  we 
have  scruples  ourselves  as  to  the  value  of  our 
services,  and  that  a  liberal  discount  from  the  face 
of  the  bill  will  about  bring  us  to  a  fair  settle- 
ment. It  will  be  better  for  all — for  patient  as 
well  as  physician — to  realize  that  the  "science  of 
human  duty"  implies  a  duty  to  oneself  as  well  as 
a  duty  to  the  public,  and  that  a  small  proportion 
of  the  charity  of  our  profession  should  begin  at 
home.  To  the  young  men  I  would  especially 
give  this  advice :  Having  settled  on  a  fair  and 
honest  fee  for  your  services,  do  not  depart  from 
this  fee.  With  us,  as  a  rule,  prosperity  in  the 
form  of  a  numerous  clientage  comes  sooner  than 
to  the  other  professions.  You  will  not  long  have 
opened  your  office  before  you  will  be  surprised 
at  the  number  who  demand  your  services.  There 
will  be  no  doubt  of  the  demand,  for  those  who 
pay  the  least  invariably  demand  the  most.  Don't 
turn  them  away,  for  if  you  properly  employ  your 
time,  you  will  gain  in  experience  and  occasionally 
a  dollar  or  two.  You  will  soon  be  enlightened  as 
to  your  popularity,  for  the  first  pay  day  will  send 


28 


THE   HOSPITAL   BULLETIN 


most  of  them  to  another  and  it  is  presumed  easier 
man.    Many  of  those  who  stick  will  tell  you  that 

Dr. never  charged  but  50  cents  a  visit,  when 

the  regular  fee  is  $1.00.   Dr. will  vigorously 

deny  this  and  produce  his  books  to  prove  his 
truth.  Here  is  everything  plain  before  you. 
Every  visit  is  listed  at  the  established  figure.  You 
will  rarely  see  his  cash  book,  for  then  the  whole 
transaction  would  be  plain,  and  you  would  dis- 
cover the  simple  manner  by  which  in  every  com- 
munity some  supposedly  ethical  man  is  supplant- 
ing his  truly  ethical  brother  by  charging  full  fees 
and  settling  for  half. 

Dr. will  cut  50  cents  or  a  dollar  from  the 

established  fees  for  out-of-town  work,  and  im- 
mensely increase  his  practice  by  it.  For  be  it 
understood  the  bone  and  sinew  of  the  land  dearly 
love  the  wholes  and  halves,  and  will  flock  to  sell 
in  the  dearest  and  pay  in  the  cheapest  market. 
Don't  envy  this  man  his  prosperity  and,  above 
all,  don't  follow  in  his  footsteps.  Bide  your 
time  with  the  assurance  that  the  man  who  charges 
$1.00  for  $2.00  worth  of  service  rarely  gives 
more  than  a  dollar's  value,  and  that  when  a  real 
emergency  arises  and  a  capable,  honest  man  is 
demanded,  one  who  respects  himself  and  his  call- 
ing, if  you  have  prepared  yourself  and  are  known 
to  give  the  best  that  is  in  you.  the  cheap  man  will 
go  to  the  wall  and  your  merit  will  receive  its  re- 
ward. If  by  chance  any  of  you  have  not  seen 
Dr.  McCormick's  paper  on  this  question  of  fees 
and  collections,  let  him  by  all  means  find  the 
proper  A.  M.  A.  Journal  and  read  it.  It  is  a 
classic  worth  any  man's  time  and  attention.  In 
concluding  this  subject,  let  me  endorse  what  he 
says  about  the  cheap  man,  the  price-cutter. 
Whatever  his  charge  may  be,  he  is  usually  get- 
ting full  value  for  his  services.  Realizing  his 
lack  of  education  or  ability  or  temperament,  or 
whatever  it  is  that  puts  him  below  his  profes- 
sional competitor,  he  cuts  his  fees  in  order  to  live. 
It  is  not  our  place  to  meet  his  competition,  but  to 
pity  him.  to  extend  to  him  the  helping  hand,  to 
endeavor  to  elevate  him  to  our  standard,  and 
never  to  lower  ourselves  to  his. 

I  have  only  a  few  words  to  say  on  the  subject 
of  professional  confidences.  So  sacred  is  the  re- 
lation between  the  physician  and  patient  regarded 
that  the  courts  will  not  compel  a  physician,  while 
on  the  witness  stand  and  under  oath,  to  tell  the 
truth,  and  not  only  the  truth,  but  the  whole  truth. 
to  reveal  what  is  imparted  to  him  in  confidence 
by  his  patient. 


If  in  this  exalted  function  of  doing  justice  be- 
tween man  and  man  the  courts  will  not  compel 
the  recital  of  some  important  piece  of  evidence, 
how  carefully  should  we  regard  our  professional 
relation,  and  see  to  it  that  neither  in  strict  confi- 
dence or  in  idle  gossip  do  we  betray  the  secrets 
that  suffering  man  has  confided  in  us. 

It  may  be  somewhat  out  of  place  in  a  paper 
dealing  with  "The  Ethics  of  the  General  Prac- 
titioner" to  speak  of  the  tendency,  or  perhaps 
better,  the  half-formed  determination  of  the  ma- 
jority of  every  class  to  be  specialists.  I  must 
confine  myself  to  the  predilection  of  the  average 
medical  student  for  surgery.  It  was  so  in  my 
day,  and  I  suppose  it  is  so  now,  that  almost  75 
per  cent,  of  the  graduating  classes  are  thoroughly 
satisfied  that  the  end  and  aim  of  medicine  is  sur- 
gery ;  that  practice  and  the  less  spectacular 
branches  are  parts  of  the  profession  essential  to 
it  as  a  whole,  and  fitted  for  those  who  intend  to 
lead  the  plodding  life,  but  too  slow  and  too  pro- 
saic for  the  man  bursting  with  the  knowledge  of 
his  own  brilliancy  and  his  own  special  fitness. 
There  is  no  question  but  that  this  tendency  has 
done  much  to  lower  the  average  fitness  of  many 
classes.  Men  become  listless  and  careless, 
neglecting  everything  but  their  hobby,  and  while 
the  surgical  amphitheatre  is  crowded,  the  medical 
clinics  will  be  shunned,  even  dsserted  were  it  not 
that  the  sections  are  such  that  the  absentees  can 
be  spotted  and  warned.  There  is  no  question 
also  but  that  indifference  to  everything  but  sur- 
gery is  responsible  for  many  of  the  failures  be- 
fore the  State  Examining  Boards.  We  must 
have  surgeons,  and  they  must  begin  their  train- 
ing in  medical  schools,  and  it  is  not  my  purpose 
to  discourage  earnest  work  and  honest  effort  to 
this  end.  I  wish,  however,  to  say  that  every 
ethical  specialist  needs  a  thorough  grounding  in 
the  general  branches  of  medicine,  and  he  should 
not  in  his  student  days  neglect  the  other  essen- 
tials to  a  well-rounded  man.  Most  heartily  do  I 
wish  to  condemn  the  careless,  happy-go-lucky 
manner  in  which  so  many  men  totally  unpre- 
pared and  totally  unsuited  by  temperament  for 
this  branch  "rush  in  where  angels  fear  to  tread." 
I  wish  especially  to  draw  your  attention  to  the 
fact  that  there  is  a  vast  difference  between  the 
operator  and  the  surgeon.  Almost  any  young 
man  with  a  disregard  of  the  sight  of  blood,  with 
nerves  unaffected  by  human  suffering  and  a  heart 
unti  inched  by  a  knowledge  of  his  power  to  do 
harm,  can  in  six  months'  practice  on  the  cadaver 


THE   HOSPITAL   BULLETIN 


29 


fearn  to  cut,  to  sew  and  to  ligate  with  neatness 
and  despatch.  Indeed,  there  may  be  many  before 
me  of  the  student  body  whose  young  and  nimble 
fingers  could  teach  dexterity  to  the  best  surgeons 
of  the  city.  Very  many  with  no  pretense  to  this 
dexterity,  and  no  equipment  but  a  superabun- 
dance of  assurance,  graduate  as  surgeons  and 
assume  and  aspire  to  a  position  of  prominence 
that  it  has  taken  the  true  surgeon  years  of  the 
hardest,  closest,  most  untiring  study,  observation 
and  work  to  reach.  We  are  told  as  an  excuse  for 
this  remarkable  evolution  from  the  student  to  the 
surgeon  that  the  young  man  of  today  is  taught 
so  much  more  than  the  old  men  were;  that  the 
very  manner  of  teaching,  the  equipment  of  the 
schools  and  the  superior  requirements  for  matric- 
ulation cannot  but  turn  out  better  posted  and 
more  competent  men.  There  is  much  truth  in 
this.  There  is  much  truth  also  in  the  fact  that 
while  more  is  taught,  more,  infinitely  more,  is 
demanded  of  the  student,  and  the  knowledge  that 
would  have  secured  him  a  diploma  fifty  years  ago 
will  now  scarcely  carry  him  through  his  fresh- 
man year. 

We  also  hear  that  "I  want  to  be  a  surgeon, 
because  surgery  accomplished  positive  results." 
This  is  very  true  also,  and  it  is  evident  that  if  you 
amputate  a  leg  your  patient  will  be  minus  a  mem- 
ber. Don't  lose  sight  of  another  fact,  however, 
that  if  without  being  competent  to  meet  any  un- 
forseen  emergency  that  may  arise,  you  lightly 
open  the  abdominal  cavity,  you  will  have  a  posi- 
tive result  in  the  shape  of  your  own  little  private 
graveyard.  The  newly  graduated  surgeon  is  not 
as  dangerous  as  the  man  who  left  medical  school 
years  ago,  before  the  students  received  one-third 
of  the  surgical  training  that  they  do  now.  Many 
of  these  men  have  not  taken  a  post-graduate 
course,  have  never  been  associated  with  a  hos- 
pital, nor  have  they  had  even  an  opportunity  for 
moderate  surgical  observation ;  and  yet  they  are 
attempting  to  do  the  work  that  only  a  skilled 
specialist  should  undertake.  I  am  not  speaking 
of  emergency  surgery  for  which  any  man  should 
try  to  prepare  himself,  and  be  brave  enough  to 
undertake  when  human  life  is  at  stake.  I  am  re- 
ferring to  operations  of  election  when  the  services 
of  a  competent  man  can  be  secured.  The  point 
is  just  this,  gentlemen,  that  medicine  as  a  science 
is  the  result  of  evolution  and  not  the  creation  of 
some  brilliant  brain ;  that  what  has  been  done  in 
it  has  been  accomplished  not  so  much  by  inspira- 


tion as  by  close  plodding  work,  exhaustive  ex- 
periment and  continual  observation ;  that  surgery 
as  one  of  its  branches  cannot  be  mastered  in  the 
four  years  of  student  life,  but  that  to  be  surgeons 
you  must  be  workers  and  observers.  It  will  not 
do  to  settle  the  matter  by  saying  that  a  man  must 
make  a  start.  This  truth  is  too  self-evident  to 
be  smart,  nor  is  it  entirely  convincing.  An 
answer  equally  true  will  be  that  you  will  not 
allow  the  embryo  surgeon  to  start  on  you,  and 
before  you  put  yourself  or  your  wife  or  your 
mother  in  his  hands  you  will  demand  that  he  pos- 
sess some  other  qualification  for  his  specialty 
besides  his  conceit,  his  gall  and  his  need  of  the 
fee.  There  may  be  some  exceptions  where  the 
man  is  born  and  not  made,  but  I  beg  to  assure 
you  that  the  surgeon  rarely  springs  full-fledged 
and  fully  fitted  from  the  brain  of  Minerva. 

Our  profession  is  nothing  if  not  altruistic.  It 
demands  daily  and  hourly  more  of  self-sacrifice, 
more  of  self-devotion,  than  any  secular  calling. 
Indeed,  the  comparison  is  often  drawn  between 
the  nobility  and  necessity  of  the  duties  which  we 
perform  and  those  of  him  who  by  divine  inspira- 
tion and  laying  on  of  hands  has  been  called  to 
succor  the  diseased  soul.  It  is  not  my  place  nor 
is  it  my  purpose  to  enter  into  a  discussion  of  this 
point,  and  I  mention  it  only  to  show  that  we  are 
marked  men  in  every  community ;  that  we  are 
placed  on  a  higher  plane  and  that  more  is  ex- 
pected of  us  than  of  our  brethren  of  the  other 
liberal  professions.  This,  indeed,  is  right,  for  no 
man,  the  priest  possibly  excepted,  enters  into 
such  intimate  relations  with  his  people.  He  is 
ever  present  with  them  to  share  their  sorrows 
and  their  joys,  and  in  his  position  of  family 
friend  and  family  confessor  it  is  his  place  to 
bind  and  salve  wounds  more  deadly  than  those 
made  by  the  hand  of  man.  It  is  a  popular  im- 
pression that  this  close  relationship  between  the 
physician  and  his  people  is  one  evolved  by  the 
brain  of  the  novelist  or  one  possessed  by  that 
most  beloved,  but  now  extinct,  old  family  physi- 
cian. Let  us  get  this  impression  from  our  minds 
and  let  us  realize  that  our  duties,  our  responsi- 
bilities and  our  relationship  to  those  we  serve  are 
just  the  same,  are  just  as  close,  and  are  just  as 
engrossing  as  they  were  when  that  dear  old  patri- 
arch of  the  profession  made  his  rounds,  scolding 
some,  chiding  others  and  advising  all  to  better, 
purer  and  nobler  lives.  Changed  as  our  relation- 
ship to  the  community  may  be  in  some  respects 


30 


THE  HOSPITAL  BULLETIN 


by  the  translation  of  many  of  the  brightest  and 
best  of  our  cult  into  the  ranks  of  the  specialist, 
it  is  still  and  always  will  be  the  general  practi- 
tioner who  is  looked  up  to  as  "the  physician," 
and  by  his  work  in  professional  and  private  life 
our  profession  will  be  judged. 

In  the  beginning  of  my  paper  I  stated  I  could 
do  little  more  than  rehearse  to  you  some  of  the 
old  axioms  and  maxims  that  have  been  handed 
down  to  us  for  generations.  I  am  aware  that  I 
have  taught  you  nothing  new  tonight,  and  that  I 
have  not  tapped  that  fountain  of  inspiration  from 
which  genius  gushes  in  poetic  or  oratorical 
streams.  I  trust  I  may  have  convinced  you  that 
it  is  not  amiss  for  us  at  times  to  hold  close  com- 
munion with  our  souls,  and  to  take  stock  of  our 
moral  and  professional  assets.  The  further  I 
have  advanced  the  more  fully  I  have  realized 
how  impossible  it  is  to  evolve  new  ideas  or  elab- 
orate new  creeds  to  supersede  those  by  which  the 
fathers  lived  and  died  and  earned  honor  for 
themselves  and  our  profession. 

So  we  face  today,  gentlemen,  just  about  the 
same  propositions  that  have  always  been  ours  to 
meet,  and  what  was  ethical  one  hundred  years 
ago  is  ethical  now. 

The  science  of  human  duty  simply  demands 
that  you  be  honest  to  yourselves,  honest  to  those 
you  serve :  that  you  may  look  every  man  squarely 
in  the  face  and  not  as  if  you  feared  he  had  heard 
something  you  had  said  behind  his  back.  May 
I  quote  to  you  the  words  of  the  Earl  of  St.  Vin- 
cent to  the  immortal  Xelson :  "It  is  given  to  us 
all  to  deserve  success ;  mortals  cannot  com- 
mand it." 


THE   STUDY  OF   RECTAL  SURGERY  IN 
NEW  YORK  CITY. 

By  J.  Dawson  Reeder,  M.  D., 

Lecturer  on  Osteology,  University  of  Maryland, 

Baltimore,  Md. 

Having  decided  to  take  a  course  in  Rectal  Sur- 
gery, I  arrived  in  New  York  ami  matriculated 
at  the  New  York  Polyclinic  Hospital  on  October 
ist  for  a  course  of  instructions  under  Prof. 
James  P.  Tuttle,  and  desire  to  herewith  describe 
briefly  my  reception : 

Professor  Tuttle  is  a  finished  surgeon  of  the 
old  school  of  gentlemen,  a  master  of  his  art,  and, 
under  all  conditions  and  circumstances,  adheres 
strictly  to  the  ethics  of  the  profession.     I  was 


not  only  most  cordially  received  by  him  socially, 
but  was  most  fortunate  in  being  honored  by  re- 
questing me  to  assist  him,  or  be  present,  on  oper- 
ations upon  his  private  patients  at  an  uptown  hos- 
pital. This  unexpected  and  friendly  honor  gave 
me  an  opportunity  to  observe  closely  the  work  of 
this  great  surgeon  in  detail,  and  I  had  the  pleas- 
ure of  witnessing  every  case  under  his  care  dur- 
ing my  three  months'  visit.  As  to  his  collossal 
work  on  cancer  of  the  rectum  and  sigmoid,  his 
results  are  too  well  known  for  me  to  dwell  upon 
at  this  time,  and  he  has  an  enviable  record  which 
makes  him  the  authority  of  this  distressing  mal- 
ady which  is  so  prevalent  in  the  cases  referred  to 
the  Rectal  surgeon,  and  have  so  long  been  un- 
recognized by  the  general  profession.  I  had  the 
pleasure  of  witnessing  him  extirpate  the  rectum 
by  his  bone-flap  and  perineal  route,  and  in  some 
of  these  cases  was  honored  by  being  his  assistant. 
As  to  the  method  and  technique  in  each  of  the 
above  mentioned.  I  will  endeavor  to  give  later. 
Another  very  important  point  gained  by  associa- 
tion with  this  surgeon  was,  that  my  own  theory 
as  to  the  merits  of  the  Whitehead  operation  were 
simply  an  endorsement  of  his  teachings,  namelv, 
that  this  particular  operation,  while  classical,  was 
only  justifiable  in  selected  cases  of  hemorrhoids, 
while  the  Clamp  and  Cautery  or  the  Ligature 
method  had  no  restrictions  as  to  variety  or  loca- 
tion of  the  pile  mass. 

Another  important  subject  was  the  question  of 
treatment  of  Tubercular  fistula.  For  a  number 
of  years  Dr.  Tuttle  said  he  was  most  discouraged 
in  his  results  and  had  almost  abandoned  any  at- 
tempt to  cure  this  class  of  infections,  but  of  late 
he  had  obtained  most  excellent  results  by  intro- 
ducing his  soft  flexible  probe  and  following  this 
tract  with  a  grooved  director;  opening  this 
throughout  its  entire  extent,  and  then  completely 
cauterizing  at  dull  red  heat  with  the  actual  cau- 
tery. This  is  then  packed  with  iodoform  gauze, 
and  since  using  the  cautery,  his  results  have  been 
decidedly  better.  Under  the  direction  of  his  as- 
sistant. Dr.  J.  M.  Lynch,  a  class  of  three  was 
formed,  with  regular  work  and  instructions  in 
the  dispensary  of  St.  Bartholomew's  Clinic, 
where  we  were  given  cases  to  diagnose  and  treat. 
This  course  consisted  in  introduction  of  procto- 
scope and  sigmoidscope  diagnosis  of  ulcerations 
specific  and  benign,  and  local  treatment  through 
this  instrument.  To  the  inexperienced  the  re- 
sults and  probabilities  gained  through  the  use  of 


THE  HOSPITAL  BULLETIN 


31 


this  pneumatic  instrument  of  Tuttle's,  which  is 
a  modification  of  the  Laws  proctoscope,  are  sur- 
prising. By  the  electric  illumination  with  which 
it  is  equipped  one  is  able  to  introduce  the  instru- 
ment with  absolute  safety  to  the  patient  for  a 
distance  of  10  to  14  inches,  exploring  the  entire 
circumference  from  the  anus  up  through  the  sig- 
moid. 

My  next  course  of  instructions  was  under  the 
direction  of  Prof.  Samuel  Gant  at  the  New  York 
Post-Graduate  Medical  School.  Dr.  Gant  like- 
wise was  most  cordial  in  his  reception,  and  on 
several  occasions  honored  me  by  entertainments, 
including  letters  of  membership  to  his  club,  and 
at  his  home  with  his  family.  Dr.  Gant,  also  a 
master  of  his  art,  has  made  a  reputation  of  re- 
nown, and  is  a  most  successful  operator.  While 
of  an  entirely  different  character  from  that  of 
Dr.  Tuttle  he  is  equally  attractive.  Dr.  Gant 
argues  that  the  majority  of  cases  of  cancer  when 
seen  by  the  specialist  are  too  far  advanced  to  offer 
any  hope  by  radical  operation,  and  generally  lim- 
its his  attempts  at  relief  to  a  colostomy.  As  to 
the  merits  of  this  procedure,  I  am  not  sufficiently 
versed  to  offer  criticism  further  than  to  say  that 
the  results  of  Dr.  Tuttle  are  certainly  encourag- 
ing to  the  surgeon  who  will  undertake  this  ordeal 
of  extirpation  in  hopes  of  eradicating  the  disease, 
while  Dr.  Gant's  operation  of  colostomy,  of 
course,  is  only  palliative,  he  making  no  claims  of 
a  cure,  except  when  the  growth  is  seen  very 
early  and  is  freely  movable ;  then  he  will  extir- 
pate. 

As  to  the  operation  for  hemorrhoids,  Dr.  Gant 
uses  ligature  and  sterile  water  anesthesia  in  near- 
ly every  case,  and  the  patient  is  thereby  cured 
without  the  administration  of  a  general  anes- 
thetic. The  difference  in  the  time  of  recovery  is 
a  question  to  be  always  considered,  in  my  own 
judgment,  and  is  as  follows:  Dr.  Tuttle  uses 
the  clamp  and  cautery  almost  universally,  and  the 
patient  is  discharged  within  the  period  of  one 
week,  while  the  ligature  method  requires  local 
treatments  to  the  ulcerations  produced  by  the 
sluffing  of  the  linen  threads,  and  takes  from  10 
clays  to  three  weeks. 

Constipation  and  Obstipation  are  treated  sur- 
gically by  both  of  these  gentlemen  by  the  opera- 
tion of  Sigmoidopexy  or  Colopexy,  which  con- 
sists in  anchoring  the  gut  to  the  abdominal  pa- 
rietes  after  having  first  stripped  back  the  perito- 
neum over  the  area  covered  by  their  sutures. 


Chronic  diarrheas  and  Amebic  Dysentery  are 
likewise  treated  by  Appendicostomy  and  Caecos- 
tomy.  The  difference  in  this  operation  being  that 
the  former  consists  in  delivering  the  appendix 
upon  the  abdomen  and  fixing  the  same  with  cat- 
gut sutures  until  the  peritoneal  cavity  is  walled 
off  by  adhesions,  and  then  amputating  later,  so 
that  the  stump  may  be  dilated  to  permit  of  regu- 
lar colonic  irrigations. 

Dr.  Gant  performs  a  similar  operation,  to 
which  he  has  applied  the  name  of  Caecostomy, 
and  having  devised  an  ingenious  director  con- 
sisting of  one  metal  rod  within  a  tube  of  slightly 
larger  calibre,  he  is  able  to  pass  the  obturator 
through  the  ileo-caecal  valve,  and  then,  by  with- 
drawing the  rod  or  obturator,  is  able  to  pass  a 
rubber  catheter  into  the  small  intestine.  The 
metal  tube  is  then  withdrawn  and  a  shorter  cath- 
eter is  placed  parallel  with  the  long  one,  which 
necessarily  is  in  the  caput,  and  after  placing  clips 
upon  each  tube  to  prevent  leakage,  he  is  able  to 
flush  out  both  large  and  small  bowel  at  desired 
intervals. 

As  to  the  irrigations  through  these  newly- 
made  openings,  it  is  a  matter  of  choice  with  dif- 
ferent operators,  those  in  greatest  favor,  I  think, 
being  Ice  Water,  Aq.  Ext  Krameria  and  Quinine 
Solution. 

A  very  interesting  case  brought  before  us  by 
Dr.  Tuttle  was  one  of  Specific  Stricture  of  the 
Rectum,  and  the  treatment  anticipated  is  as  fol- 
lows: He  performed  a  Maydl-Reclus  Colostomy 
in  the  transverse  colon,  in  order  first  to  treat  the 
ulcerations  and  infected  area  locally,  and,  sec- 
ondly, so  that  he  would  have  sufficient  gut  above 
the  stricture  to  do  a  Perineal  extirpation  later 
and  bring  down  new  healthy  intestine  from  the 
upper  Sigmoid  for  a  new  permanent  anus ;  then 
later  he  would  close  the  artificial  anus  in  the 
transverse  colon,  and  his  patient  should  have  a 
perfect  result.  The  period  required  for  these 
three  operations  would  cover  a  period  of  not  less 
than  nine  months:  and  if  after  this  there  is  not 
perfect  Sphincteric  action,  Dr.  Tuttle  does  a 
plastic  operation  to  repair  his  sphincter. 

Before  continuing  with  a  brief  description  of 
the  technique  of  Extirpation  as  above  referred 
to,  I  wish  to  herewith  express  my  sincere  grati- 
tude and  appreciation  of  the  many  honors  and 
courtesies  extended  to  me  by  these  gentlemen, 
and  am  quite  sure  that  the  same  was  not  all  per- 
sonal, but  honor  to  the  University  of  Maryland's 


3:2 


THE   HOSPITAL  BULLETIN 


Faculty  of  Physic,  who  have  aided  so  materially 
this  younger  specialty  by  such  men  as  Hem- 
meter,  Pennington  and  Earle,  who  are  constantly 
quoted  by  all  intestinal  and  rectal  surgeons. 

EXTIRPATION    OF    RECTUM. 

The  operation  of  removing  the  rectum  is  now 
almost  two  centuries  old.  Faget  performed  it  in 
1739,  but  Listfrane  first  successfully  extirpated 
the  rectum  for  cancer  in  1826.  The  results  of 
the  operation  in  nine  cases  were  embodied  in  a 
thesis  by  one  of  his  students  (Penault,  Thesis, 
Paris,  1829),  and  in  1833  the  great  surgeon  him- 
self gave  to  the  world  a  complete  account  of  his 
operation  and  method,  thus  establishing  the  pro- 
cedure as  a  surgical  measure.  The  results  in 
these  cases  were  not  calculated  to  create  any 
great  enthusiasm,  for  the  mortality  was  high 
owing  to  the  lack  of  aseptic  technique.  The 
methods  described  in  older  books  give  us  five 
varieties  of  operation  for  extirpation  —  the  pe- 
rineal, the  sacral,  the  vaginal,  the  abdominal  and 
the  combined.  In  this  paper  I  shall  only  en- 
deavor to  describe  briefly  the  two  methods  used 
by  Dr.  Tuttle.  Before  describing  these  methods 
in  detail  it  may  be  well  to  consider  the  prepara- 
tion of  the  patient,  which  is  practically  the  same 
in  each.  In  order  to  obtain  the  best  results,  it  is 
necessary  to  increase  the  patient's  strength  as 
far  as  possible  by  forced  feeding  for  a  time,  to 
empty  the  intestinal  tract  of  all  hard  and  putri ty- 
ing faecal  masses,  to  establish  as  far  as  we  may 
intestinal  antisepsis  and  to  check,  in  a  measure, 
the  purulent  secretion  from  the  growth.  It  re- 
quires from  7  to  10  days,  or  longer,  to  properly 
prepare  a  patient  for  this  operation.  The  diet 
best  calculated  to  obtain  a  proper  condition  of  the 
intestinal  tract  is  generally  conceded  to  be  a  ni- 
trogenous one.  The  absolute  milk  diet  is  not  so 
satisfactory  as  a  mixed  diet  composed  of  meat, 
strong  broth,  milk  and  a  small  quantity  of  bread 
and  refined  cereals.  The  patient  should  be  fed 
at  frequent  intervals,  and  as  much  as  he  can  di- 
gest. Along  with  this  forced  feeding  one  should 
administer  daily  a  saline  laxative  which  will  pro- 
duce two  or  three  thin  movements,  and  to  disin- 
fect the  intestinal  canal  one  should  give  through 
the  stomach  three  or  four  times  a  day  sulpho- 
carbolate  of  zinc,  grs.  iiss.,  in  form  of  an  en- 
teric pill.  On  the  day  previous  to  the  operation 
the  perinaeum,  sacral  region  and  pubis  should  be 
shaved,  dressed  with  a  soap  poultice  for  two 
hours,  then  washed  and  dressed  with  bichloride 


dressing,  which  should  be  retained  until  patient  is 
anesthetized.  Notwithstanding-  all  of  these  prep- 
arations, it  is  impossible  to  obtain  absolute  asep- 
sis of  the  affected  area,  and  so  many  fatalities 
occur  from  infection  that  it  is  deemed  wise  by 
many  surgeons  to  make  an  artificial  inguinal 
anus  as  a  preliminary  procedure  in  all  extirpa- 
tions of  the  rectum. 

PERINEAL    METHOD. 

Under  this  method  may  be  included  certain 
operations  for  small  epitheliomas  low  down  in 
the  rectum  done  through  the  anus.  The  patient 
having  been  properly  prepared,  the  sphincter  is 
thoroughly  dilated ;  a  circular  incision  through 
the  entire  wall  of  the  gut  is  made,  and  the  seg- 
ment is  caught  with  traction  forceps  and  dragged 
by  an  assistant  while  the  operator  frees,  by  scis- 
sors and  blunt  dissection,  to  a  point  at  least  one- 
half  inch  above  the  cancer.  The  free  end  of  the 
gut  is  then  tied  with  strong  tape,  as  the  tempta- 
tion is  very  great  to  put  your  finger  in  the  bowel 
as  a  guide,  and  thereby  invite  infection.  A  deep 
dorsal  incision  is  then  made,  going  down  to  the 
right  of  the  coccyx  through  the  post-rectal  tissue. 
The  hand  is  then  placed  in  the  sacral  fossa  and 
the  structures  lifted  out  into  the  pelvis,  after 
which  this  space  is  thoroughly  packed  with  gauze 
to  control  the  bleeding  and  hold  the  structures 
out  of  the  fossa.  •  The  edges  of  the  wound,  in- 
cluding each  half  of  the  sphincter  which 
has  been  cut  posteriorly,  are  held  by  flat  retract- 
ors, while  the  operator  proceeds  to  dissect  the 
anterior  portion  of  the  rectum  loose  from  its  at- 
tachments. A  sound  should  be  held  in  the 
urethra  in  men  and  an  assistant's  finger  in  the 
vagina  in  women  to  prevent  wounding  these  or- 
gans. After  the  gut  has  been  dissected  out  well 
above  the  tumor,  it  is  caught  by  clamps  and  cut 
off  below  these.  Bleeding  is  controlled  by  liga- 
tures and  equal  parts  of  hot  water  and  alcohol. 
This  newly-exposed  gut  is  then  sterilized  by  pure 
carbolic  acid  and  alcohol,  or  may  be  seared  with 
cautery.  Sometimes  the  peritoneum  can  be 
stripped  off  from  the  rectum  and  its  cavity  need 
not  be  opened ;  it  is  better,  however,  to  open  the 
cavity  at  once  when  the  growth  extends  above 
this  point.  The  peritoneum  is  incised,  cut  loose 
from  its  attachments  close  to  the  rectum,  back  to 
the  mesorectum.  which  should  be  cut  close  to  the 
sacrum,  in  order  to  avoid  the  inferior  mesenteric 
artery.  When  the  gut  has  been  loosened  suffi- 
ficientlv  above  the  tumor,  it  mav  be  still  fastened 


THE   HOSPITAL   BULLETIN 


3$ 


by  two  lateral  peritoneal  reflections,  which  are 
the  lateral  rectal  ligaments,  and  should  be  cut  at 
once.  The  gut  is  then  brought  down  and  sutured 
to  the  anus,  and  the  operator  should  proceed  to 
close  the  peritoneum  and  restore  the  planes  of 
the  pelvic  floor  down  to  the  levator  ani  by  fine 
catgut  sutures.  After  this  has  been  accom- 
plished, the  anus,  which  is  now  well  outside  the 
operative  field,  should  be  reopened,  the  gauze 
removed,  and  the  gut  flushed  with  a  solution  of 
bichloride  or  peroxide  of  hydrogen.  Ouenu  ad- 
vises that  in  amputating  each  layer  should  be  cut 
separately,  in  order  to  avoid  hemorrhage,  but 
there  appears  to  be  no  advantage  in  this ;  in  fact, 
we  are  more  likely  to  meet  with  deficient  blood 
supply,  causing  subsequent  sloughing  of  the  gut, 
than  with  hemorrhage.  The  posterior  and  ante- 
rioT  portions  of  the  perineal  wound  are  packed 
with  gauze  and  left  open  to  assure  drainage,  and 
the  parts  are  covered  with  aseptic  pads,  held  in 
position  by  a  well-fitting  "T"  bandage.  A  large 
drainage  tube  is  passed  well  up  into  the  rectum, 
its  lower  end  extending  outside  of  the  dressings, 
in  order  to  convey  the  discharges  and  gases  be- 
yond the  operative  wound. 

tuttle's  bone  flap  operation. 

"The  Kraske  Operation"  is  applied  to  various 
methods  in  which  access  to  the  rectum  is  ob- 
tained by  removing  the  coccyx  or  cutting  off 
certain  portions  of  the  lower  end  of  the  sacrum. 
They  are  all  modifications  of  Kraske's  original 
method,  with  which  we  are  all  familiar.  Dr. 
Tuttle  has  modified  this  plan,  as  it  furnishes  a 
rapid  and  adequate  approach  to  the  rectum  ;  it 
facilitates  the  control  of  hemorrhage  and  restores 
the  bony  floor  of  pelvis  and  attachment  of  the 
anal  muscles,  and  involves  injury  of  the  sacral 
nerves  and  lateral  sacral  arteries  on  one  side 
only.  The  technique  which  he  employs  is  as  fol- 
lows : 

The  patient  is  previously  prepared  as  hereto- 
fore described,  and  an  artificial  anus  established 
or  not,  as  the  conditions  indicate ;  before  the  final 
scrubbing  the  sphincter  should  be  dilated  and  the 
rectum  irrigated  with  bichloride  1-2000  or  hydro- 
gen peroxide.  It  should  then  be  packed  with  ab- 
sorbent gauze,  so  that  the  finger  cannot  be  intro- 
duced. The  patient  is  then  placed  in  the  prone 
position  on  the  left  side,  with  the  hips  elevated 
on  a  hard  pillow  or  sandbag ;  an  oblique  incision 
is  made  from  the  level  of  the  third  foramen  on 
right  side  of  sacrum  down  to  the  tip  of  the  coc- 


cyx, and  extending  half-way  between  this  point 
and  the  posterior  margin  of  the  anus. 

This  incision  should  be  made  boldly  with  one 
stroke  through  the  skin,  muscles  and  ligaments 
into  the  cellular  tissue  posterior  to  the  rectum ; 
the  rectum  is  then  rapidly  separated  by  the  fin- 
gers from  the  sacrum,  and  the  space  thus  formed 
and  the  wound  should  be  firmly  packed  with 
sterile  gauze.  A  transverse  incision  down  to  the 
bone  is  then  made  at  a  level  of  the  4th  sacral 
foramen,  the  bone  is  rapidly  chiseled  off  in  this 
line,  and  the  triangular  flap  is  pulled  down  to  the 
left  side  and  held  by  retractor.  At  this  point  it 
is  usually  necessary  to  catch  and  tie  the  right 
lateral  and  middle  sacral  arteries.  Frequently 
these  are  the  only  vessels  that  need  to  be  tied 
during  the  entire  operation,  although  if  one  cuts 
too  far  away  from  the  sacrum,  the  right  sciatic 
may  be  severed.  The  first  step  in  the  actual  ex- 
tirpation of  the  rectum  consists  in  isolating  the 
organ  below  the  level  of  the  resected  sacrum,  so 
that  a  ligature  can  be  thrown  around  it,  or  a  long 
clamp  applied  to  control  any  bleeding  from  its 
walls.  If  the  neoplasm  extends  above  this  level 
and  it  is  necessary  to  open  the  peritoneal  cavity 
to  extirpate  it,  one  should  do  this  at  once,  as  it 
will  be  found  much  easier  to  dissect  the  rectum 
out  by  following  the  course  of  the  peritoneal 
folds.  By  opening  the  peritoneum  and  incising 
its  lateral  folds  close  to  the  rectum,  the  danger 
of  wounding  the  ureters  is  greatly  decreased  and 
the  gut  is  much  more  easily  dragged  down. 

When  the  posterior  peritoneal  folds  or  meso- 
rectum  is  reached,  the  incision  should  be  carried 
as  far  away  from  the  rectum,  or,  rather,  as  close 
to  the  sacrum,  as  possible  in  order  to  avoid 
wounding  the  superior  hemorrhoids  artery,  and 
to  remove  all  the  sacral  glands.  The  gut  should 
be  loosened  and  dragged  down  until  its  healthy 
portion  easily  reaches  the  anus  or  healthy  seg- 
ment below  the  growth.  A  strong  clamp  should 
then  be  placed  upon  the  intestine  about  one  inch 
above  the  neoplasm,  but  should  never  be  placed 
in  the  area  involved  by  it ;  for  in  so  doing  the 
friable  walls  may  rupture  and  the  contents  of 
the  intestine  be  poured  out  into  the  wound.  As 
soon  as  the  gut  has  been  sufficiently  liberated 
and  dragged  down,  the  peritoneal  cavity  should 
be  cleansed  by  wiping  with  dry  sterilized  gauze 
and  closed  by  sutures  which  attach  the  mem- 
brane to  the  gut.  By  this  procedure  the  entire 
intraperitoneal  part  of  the  operation  is  completed 


34 


THE   HOSPITAL  BULLETIN 


and  this  cavity  closed  before  the  intestine  is  in- 
cised. After  this  is  done  the  gut  should  be  cut 
across  between  two  clamps  or  ligatures  above  the 
tumor,  the  ends  being  cauterized  with  carbolic 
acid  and  covered  with  rubber  protective  tissue. 
The  lower  segment  containing  the  neoplasm  may 
then  be  dissected  from  above  downward  in  an 
almost  bloodless  manner  until  the  lowest  portion 
is  reached.  It  is  much  more  easily  removed  in 
this  direction  than  from  below  upward,  and  there 
is  less  danger  of  wounding  the  other  pelvic  or- 
gans. If  the  neoplasm  extends  within  one  inch 
of  the  anus,  it  will  be  necessary  to  remove  the 
entire  lower  portion  of  the  rectum.  If,  how- 
ever, more  than  one  inch  of  perfectly  healthy 
tissue  remains  below,  this  should  always  be  pre- 
served. Having  removed  the  neoplasm,  if  one 
inch  or  more  of  healthy  gut  remains  above  anus, 
one  should  unite  the  proximal  and  distal  ends 
either  by  Murphy  button  or  end-to-end  suture. 

All  oozing  is  checked  by  hot  compresses,  and 
the  concavity  of  the  sacrum  is  packed  with  a 
large  mass  of  sterilized  gauze,  the  end  of  which 
protrudes  from  the  lower  angle  of  the  wound. 
This  serves  to  check  the  oozing,  and  also  fur- 
nishes a  support  to  the  bone-flap  after  it  has  been 
restored  to  position.  Finally  the  flap  is  fastened 
in  its  original  position  by  silk-worm  gut  sutures, 
which  pass  deeply  through  the  skin  and  perios- 
terum  on  each  side  of  the  transvere  incision. 
Suturing  the  bone  itself  is  not  necessary.  The 
lateral  portion  of  the  wound  is  closed  by  similar 
sutures  down  to  the  level  of  the  sacro-coccygeal 
articulation  :  below  this  it  is  left  open  for  drain- 
age (Tuttle,  Diseases  of  Rectum,  Page  829 — 
I903)- 


REPORT  OF  A  CASE  OF  GANGRENOUS 

APPENDICITIS,  FROM  THE  SERVICE 

OF  PROF.  R.  WINSLOW. 

By  C.  C.  Smixk,  '09, 
Senior  Medical  Student. 

In  selecting  a  case  I  have  not  taken  one  that  is 
a  surgical  curiosity,  or  at  all  an  unusual  one,  but 
I  have  taken  this  because  it  is  just  in  these  cases 
that  a  doubt  sometimes  exists  as  to  the  treat- 
ment when  diagnosed,  and  often  the  condition  of 
the  appendix  and  surrounding  peritoneum  is  in 
doubt,  even  if  a  diagnosis  of  trouble  originating 
in  the  appendix  is  made. 

History  of  Case — Patient,  a  boy,  L.  \Y.,  age 


9  years,  schoolboy;  admitted  December  26,  1908, 
with  a  diagnosis  of  appendicitis. 

Family  History — Parents  well ;  one  brother 
died  in  infancy,  cause  unknown ;  two  brothers 
living  and  well;  only  history  of  any  family  dis- 
ease is  tuberculosis  in  one  uncle;  no  rheumatism, 
syphilis,  gout,  haemophalia  or  other  disease 
bearing  on  the  case. 

Past  History — Measles  at  5  years,  with  une- 
ventful recovery;  whooping-cough  at  6,  no  com- 
plications ;  badly  burned  two  years  ago ;  has  had 
"indigestion"  (?)  since  he  was  3  years  old;  pain 
but  no  tenderness  during  these  attacks ;  treated 
by  different  physicians  and  got  better  for  a  time ; 
no  history  of  scarlet  fever,  influenza,  pneumonia, 
typhoid  or  other  disease  of  childhood. 

Habits — A  normal  child. 

Present  Illness — On  20th  of  December,  1908, 
patient  came  home  from  church  complaining  of 
pains  in  the  right  side.  This  was  Sunday.  Next 
day  he  complained  of  severe  pain  all  over  abdo- 
men, but  on  Tuesday  these  became  localized  in 
the  right  lower  quadrant  of  the  abdomen.  Had 
some  fever.  Bowels  constipated.  No  nausea  or 
vomiting.  There  was  a  localized  tenderness  in 
the  right  lower  quadrant  from  the  start.  Pains 
got  better  on  Friday,  but  temperature  and  pulse 
still  stayed  up,  and  patient  came  into  hospital  on 
Saturday,  December  26.  The  unusual  feature 
was  that  there  was  no  nausea  or  vomiting.  It  is 
also  to  be  noted  that  the  pain  subsided  suddenly 
on  the  24th.  The  child  entered  hospital  on  the 
26th.  and  on  entrance  the  whole  right  side  was 
rigid,  while  the  left  side  was  comparatively  soft. 
A  lump  could  be  felt  in  the  appendical  region,  the 
centre  of  which  was  above  McBurney's  point. 
Temperature  was  99  and  pulse  78.  The  leuco- 
cyte count,  however,  was  30.200 ;  urine  negative. 

Child  was  put  to  bed ;  an  ice  cap  placed  on  the 
abdomen.  Liquid  diet.  The  next  day,  December 
27th,  leucocytes  stood  at  35,200.  Temperature 
unchanged,  but  the  pulse  had  risen  to  no  beats. 
A  hypodermic  of  morphine  and  atrophine  was 
given,  and  patient  taken  to  the  operating  room, 
anesthetized,  and  abdomen  cleaned  for  an  asep- 
tic (if  possible)  operation. 

Prof.  Winslow  made  an  incision  in  the  abdom- 
inal wall,  well  out  toward  the  crest  of  the  ilium, 
using  the  gridiron  incision.  The  caecum  was 
found  and  pulled  over  toward  the  middle  line, 
and  in  looking  for  the  appendix,  which  was  sup- 
posed to  be  behind  the  caecum,  a  great  quantity 


THE   HOSPITAL  BULLETIN 


35 


of  pus  was  found.  This  nasty  smelling,  grayish 
pus  welled  up  into  the  wound  and  was  sponged 
away.  Several  pieces  of  mucous  membrane  and 
presumably  the  tip  of  the  appendix  were  found  in 
the  pus.  Also  several  faecal  secretions.  The  pus 
was  sponged  away  and  carefully  a  search  was 
made  for  the  appendix,  or  rather  what  remained 
of  it.  It  was  found  tied  down  by  adhesions  and 
dissected  loose.  It  broke  away  in  pieces,  and  it 
was  unnecessary  to  ligate  any  of  the  arteries  of 
the  meso  appendix.  The  stump  of  the  appendix 
close  to  the  caecum  was  crushed,  cauterized  and 
ligated.  No  attempt  was  made  to  invert  it,  as 
the  tissues  would  not  stand  it.  The  pus  cavity 
was  found  to  extend  up  behind  the  caecum  and 
over  toward  the  median  line  for  some  distance. 
The  puncture,  which  I  will  refer  to  later,  was 
then  made  in  the  right  lumbar  region,  and  two 
cigarette  drains  were  introduced  extending  clear 
back  into  the  bottom  of  the  abscess  cavity.  Then 
a  gauze  drain  was  introduced  into  the  anterior 
wound,  and  this  sutured  up.  The  wound  was 
then  dressed  and  the  patient  taken  to  the  ward. 
Recoverv  from  anesthetic  without  ill  effects. 

The  next  morning  the  patient  was  unable  to 
pass  his  water,  and  had  to  be  catheterized.  Aside 
from  this  no  ill  effects  were  seen,  and  his  tem- 
perature and  pulse  remained  practically  at  the 
same  place.  At  the  end  of  48  hours  the  drains 
and  dressings  were  changed  and  the  patient  was 
doing  well  and  the  wound  draining  profusely. 
At  no  time  was  the  bed  elevated  and  at  no  time 
was  a  stimulant  administered,  with  the  exception 
of  a  hot  normal  salt  enema  on  the  day  following 
the  operation.  Several  times  during  his  stay  a 
dose  of  castor  oil  was  given,  but  no  other  medica- 
tion was  necessary.  As  the  dressings  were  reap- 
plied and  drains  introduced  daily  the  wounds 
were  found  to  be  granulating'  up,  and  gradually 
these  closed,  first  the  one  in  the  lumbar  region 
and  then  the  one  in  the  abdomen.  By  the  tenth 
day  a  normal  temperature  was  present,  and  he 
sat  up  on  the  twelfth. 

The  child  went  on  to  an  uneventful  recovery, 
and  went  home  on  January  21st  fully  cured. 

This  was  undoubtedly  one  of  those  cases  of 
gangrenous  appendicitis  where,  owing  either  to 
the  intensity  of  the  infection  or  to  a  thrombosis 
of  the  vessels  supplying  the  appendix,  the  vitality 
of  the  tissues  is  lost  and  gangrene  results.  Now, 
"even  in  this,  the  gravest  form  of  appendicitis, 
the  general  peritoneal  cavity  is  often  protected 
against  infection  by  walling  off  the  pus,  and  the 


appendix,  detached  in  the  form  of  a  slough,  is 
often  found  on  opening  the  localized  abscess." 
But  "in  other  cases  there  is  from  the  beginning 
the  symptoms  of  peritoneal  sepsis  and  perito- 
nitis." 

Now,  it  seems  to  me  that  a  great  deal  depends 
on  the  kind  of  infection — or,  rather,  the  kind  of 
organism  infecting — and  often  the  difference  be- 
tween a  localized  abscess  and  a  general  peritonitis 
is  really  the  difference  between  a  colon  and  a 
streptococcus  infection.  Again,  should  a  general 
peritonitis  develop,  I  have  noticed  from  a  num- 
ber of  cases  in  the  wards  that  the  prognosis  prac- 
tically depends  on  the  organism,  although  we  all 
know  that  a  general  peritonitis  is  a  mighty  grave 
condition,  no  matter  what  it  is  due  to. 

Another  point  in  favor  of  the  child  was  the 
fact  that  the  gangrenous  process  seemed  to  start 
in  the  tip  of  the  appendix,  and  it  seems  that  when 
it  starts  there,  there  is  greater  likelihood  of  lo- 
calization, and  when  it  starts  in  the  base  a 
greater  likelihood  of  general  peritonitis. 

I  said  that  there  was  often  doubt  as  to  the  con- 
dition in  the  abdomen  in  these  cases.  Now,  there 
can  be  no  doubt  that  the  two  main  points  in  the 
diagnosis  of  a  localized  abscess  are  tumor  and 
an  aggravation  of  the  symptoms  present.  But 
this  case  exemplified  the  fact  that  there  may  be 
cases  where  there  is  no  aggravation  of  symp- 
toms, and  in  a  great  many  cases  it  may  be  im- 
possible to  feel  the  tumor  until  it  has  become 
very  large,  owing  to  its  situation,  viz.,  post  cae- 
cal.  Even  in  this  case,  from  which  a  great  quan- 
tity of  pus  was  evacuated,  there  was  no  absolute 
certainty  of  finding  pus  on  opening  the  abdomen, 
although  it  was  suspected  strongly. 

I  have  seen  a  patient  walk  into  the  hospital  on 
Sunday  with  a  temperature  of  100  and  a  pulse  of 
99,  and  when  the  abdomen  was  opened  on  Mon- 
day morning  a  most  virulent  form  of  general 
streptococcus  peritonitis  was  found,  from  which 
the  patient  died  the  next  day.  It  is  said  that  it  is 
much  better  to  depend  on  the  pulse  and  its  varia- 
tions than  on  the  temperature. 

I  would  like  to  call  attention  to  several  points 
in  the  treatment  of  this  case  also. 

First,  the  place  of  incision  was,  as  I  said,  well 
up  towards  the  iliac  crest,  and  not  in  the  time- 
honored  McBurney  point.  The  wisdom  of  this  is 
self-evident. 

Second,  the  care  used  in  not  breaking  up  the 
wall  of  the  abscess  formed  by  the  peritoneum. 


3ti 


THE   HOSPITAL   BULLETIN 


Also,  the  fact  that  the  appendix  was  carefully 
dissected  up  and  tied  off  and  allowed  to  heal  by 
itself,  obviating,  as  much  as  possible,  the  danger 
of  a  faecal  fistula.  The  older  books  advised 
evacuating  the  abscess  and  leaving  the  appendix 
to  slough  off,  and,  while  I  have  seen  seven  cases 
where  this  method  was  used  and  not  a  single 
faecal  fistula,  yet  it  seems  to  me  the  more  rational 
treatment  to  remove  the  offender,  as  I  have  also 
assisted  in  three  operations  where  the  appendix 
was  removed  at  the  second  operation.  That  is, 
an  operation  supposedly  an  appendectomy  was 
done,  and  later,  at  a  subsequent  period,  the  dis- 
eased appendix  was  found  still  causing  the  same 
old  trouble. 

Again,  the  use  of  the  lumbar  puncture,  so  as 
to  drain  the  abscess  cavity  from  its  very  bottom. 
I  wonder  this  is  not  done  oftener,  as  it  appeals 
to  me  as  being  a  most  sensible  thing. 

Then  the  abscess  cavity  was  sponged  out  with 
gauze,  and  not  washed  out  with  the  antiseptic 
fluid  that  books  advise,  thus  spreading  bacteria 
all  over  the  peritoneal  cavity,  and  really  doing 
no  good.  Nature  was  allowed  to  throw  off  such 
things  as  she  deemed  necessary,  an  avenue  of  es- 
cape having  been  provided. 

And,  lastly,  the  omentum  was  found  and 
brought  down,  covering  in  the  cavity  as  much  as 
possible,  and  thus  aiding  in  the  walling  off  pro- 
cess. 


DIRECT  LARYNGOSCOPY. 

By  Richakd  H.  Johnstox,  M.  D. 

Read  Before  the  Baltimore  City  Medical  Society, 

Section  on  Medicine  and  Surgery, 

February,  1909. 

Direct  laryngoscopy,  as  the  name  implies,  is  the 
inspection  of  the  larynx  through  a  hollow  tube 
without  the  use  of  a  mirror.  The  examination  is 
made  with  the  patient  in  the  sitting  position, 
under  local  anesthesia,  or  in  the  prone  position, 
tinder  general  anesthesia.  To  examine  the  larynx 
in  the  sitting  position  it  is  practically  always  nec- 
essary to  give  a  hypodermic  injection  of  morphia 
and  atropia  a  half  hour  beforehand,  to  relax  the 
muscles  and  to  prevent  excessive  secretion.  The 
patient  is  seated  upon  a  low  stool  with  the  head 
extended  and  supported  by  an  assistant.  With 
curved  forceps  20%  cocaine  or  25%  alypin  solu- 
tion is  quickly  passed  into  the  throat,  anesthetiz- 
ing pharynx,  tongue  and  epiglottis.  Jackson's 
slide  speculum  is  then  introduced  and  the  base  of 
the  tongue,  with  the  epiglottis,  gently  pulled  for- 
ward. At  this  point  it  is  usually  necessary  to  use 
more  cocaine  directly  in  the  larynx,  which  is  intro- 
duced by  means  of  special  cotton  carriers.  In  a  few 
minutes  anesthetization  is  complete,  and  the  ex- 
amination can  be  made  at  leisure.  It  will  be 
found  easier  to  inspect  the  different  parts  of  the 
larynx  if  the  head  is  held  about  halfway  between 
the   erect   position    and   complete   extension.      In 


some  patients  with  short,  thick  necks  and  large 
middle  incisor  teeth  the  slide  will  have  to  be  re- 
moved from  the  speculum  to  enable  one  to  see 
well.  The  examination  in  the  prone  position 
under  general  anesthesia  is  made  with  the 
patient's  head  over  the  end  of  the  table  supported 
by  an  assistant.  The  speculum  is  introduced  and 
the  base  of  the  tongue  and  the  epiglottis  pulled 
upward  forcibly.  In  this  position  direct  laryn- 
goscopy, even  in  children,  is  unsatisfactory,  and 
operative  procedures  are  well-nigh  impossible  on 
account  of  the  muscular  rigidity.  The  force  re- 
quired to  lift  the  tissues  is  so  great  and  the  posi- 
tion of  the  arm  is  so  cramped  that  it  is  difficult 
to  get  a  clear  view  of  the  field.  The  difficulty  has- 
impressed  all  who  have  worked  in  this  particular 
line.  It  remained  for  Dr.  H.  P.  Mosher,  of  Bos- 
ton, to  discover  a  method  of  direct  laryngoscopy" 
which  makes  it  as  simple  under  ether  anesthesia 
as  in  the  sitting  position.  In  April,  1908,  he  de- 
scribed in  the  Boston  Medical  and  Surgical  Jour- 
nal the  "left  lateral  position"  for  examining  the 
larynx  and  the  upper  end  of  the  esophagus.  He 
designed  certain  instruments  which  I  believe  are 
too  cumbersome  to  meet  with  popular  favor.  In 
Mosher's  position  the  patient  lies  on  the  table 
with  the  head  turned  toward  the  left  until  the 
cheek  almost  rests  on  the  table;  the  chin  is  flexed 
on  the  chest.  In  our  work  at  the  Presbyterian 
Hospital  we  have  found  a  modified  Mosher's  po- 
sition and  Jackson's  child  speculum  the  ideal  com- 
bination for  the  examination  in  the  prone  patient. 
In  children  the  procedure  is  carried  out  with  or 
without  anesthesia.  Without  anesthesia  the  headr 
hands  and  feet  are  held,  the  chin  is  flexed  on  the 
chest  in  a  normal  position  by  placing  a  pillow 
under  the  head,  the  speculum  is  introduced  and 
the  larynx  inspected.  In  adults  under  anesthesia 
the  same  procedure  is  used,  and  will  be  found 
much  simpler  than  the  extended  position.  In 
adults,  after  the  speculum  is  in  position,  if  the 
anterior  part  of  the  larynx  is  not  seen,  gentle 
pressure  on  the  thyroid  cartilage  will  bring  the 
anterior  commissure  into  view.  Operations  can 
be  done  through  the  tube  satisfactorily.  With 
the  different  methods  of  direct  laryngoscopy  it  is- 
possible  to  remove  any  growth  from  the  larynx. 
919  N.  Charles  Street. 


ITEMS. 


The  Board  of  Trustees  of  the  Permanent  En- 
dowment Fund  of  the  University  held  its  annual 
meeting  on  January  11.  Judge  Stockbridge  was- 
re-elected  president  and  Mr.  J.  Harry  Tregoe  sec- 
retary-treasurer, and,  with  Dr.  Samuel  C.  Chew 
and  Judge  Sams,  constitute  the  executive  com- 
mittee for  the  year  1909.  The  funds  and  securi- 
ties in  hand  total  the  gross  sum  of  $18,635.74. 


A  special  meeting  of  the  Washington  Branch 
of  the  General  Alumni  Association  was  held  at 


THE   HOSPITAL  BULLETIN 


37 


the  office  of  the  president,  Dr.  Monte  Griffith, 
March  n,  1909,  to  consider  the  advisability  of 
petitioning  the  Board  of  Regents  to  establish  a 
Board  of  Alumni  Counsellors,  a  paid  president 
and  a  Board  of  Trustees,  independent  of  the 
teaching  faculties.  Resolutions  in  favor  of  these 
measures  were  adopted. 


Dr.  Louis  W.  Knight,  class  of  1866,  of  Balti- 
more, has  presented  to  Loyola  College  a  valuable 
collection  of  papal  medals. 


Drs.  H.  O.  and  J.  N.  Reik  have  removed  their 
offices  to  506  Cathedral  street. 

Drs.  W.  D.  Scott  and  W.  E.  Wiegand  attended 
the  banquet  of  the  Virginia  Military  Institute 
Alumni  Association  of  Baltimore,  held  at  the 
New  Howard  House,  March  2,  1909.  Dr.  W.  D. 
Scott  responded  to  the  toast  "The  Younger  Gen- 
eration and  the  Splendid  Work  of  the  Virginia 
Military  Institute  Today." 


Major  William  F.  Lewis,  class  of  1893,  U.  S. 
A.  Medical  Corps,  has  been  relieved  from  duty  at 
Fort  Thomas  and  ordered  to  sail  on  June  5,  1909, 
for  the  Philippine  Islands,  via  San  Francisco,  for 
duty. 


Dr.  Hugh  A.  Maughlin,  class  of  1864,  of  121 
North  Broadway,  an  official  in  the  United  States 
Custom  Service,  who  was  assistant  surgeon  in 
the  Sixth  Maryland  Regiment  during  the  Civil 
War,  is  dangerously  ill  of  pleurisy  at  his  home. 
Dr.  Maughlin  is  a  member  of  Wilson  Post,  G. 
A.  R. 


Dr.  James  A.  Nydegger,  class  of  1892,  past  as- 
sistant surgeon,  United  States  Public  Health  and 
Marine  Hospital  Service,  has  been  promoted  to 


the  rank  of  surgeon. 


Dr.  Eugene  H.  Mullan,  class  of  1903,  assistant 
surgeon,  United  States  Public  Health  and  Marine 
Hospital  Service,  has  been  commissioned  a  past 
assistant  surgeon,  to  rank  as  such  from  February 

2,   1909. 


Dr.  Samuel  T.  Earle,  Jr.,  of  Baltimore,  Aid  , 
records  the  case  of  Mrs.  F.  H.  D.,  who,  the  latter 
part  of  August,  1907,  while  eating  ham,  swal- 
lowed a  plate  with  two  false  teeth.  Ten  days 
later  she  had  a  violent  attack  of  pain  in  the  abdo- 
men, followed  by  a  chill  and  fever.  There  was 
no  recurrence  of  this  for  one  and  a  half  months. 
Since  then  they  have  recurred  from  time  to  time. 
but  not  as  severe,  nor  have  they  been  attended 
with  chill  and  fever.  A  diagram  taken  of  the 
lower  abdominal  and  pelvic  regions  showed  the 
plate  in  the  sigmoid  flexure  of  the  colon,  on  a 
level  with  the  promontory  of  the  sacrum.  Exam- 
ination through  the  sigmoidoscope  brought  it  into 
view  at  the  point  shown  by  the  X-ray.    There  was 


considerable  tenesmus,  and  the  passage  of  a  good 
deal  of  mucous,  also  a  tendency  to  constipation. 
Under  the  influence  of  two  hypodermics  of  mor- 
phine, gr.  1-4,  hyoscine  hydrobromate,  gr.  gr. 
L-100,  and  cactina,  which  produced  satisfactory 
anesthesia,  Dr.  Earle  was  able  to  grasp  the  plate 
through  the  sigmoidoscope  with  a  pair  of  long- 
alligator  forceps,  and  withdraw  it  immediately 
behind  the  sigmoidoscope. 


At  the  Conference  on  Medical  Legislation,  held 
in  Washington,  D.  C,  January  18-20,  1909,  reso- 
lutions were  adopted  providing  for  a  committee 
composed  of  one  member  each  from  the  medical 
departments  of  the  Army  and  the  Navy,  one  from 
the  Public  Health  and  Marine  Hospital  Service, 
one  member  from  the  District  of  Columbia  and 
one  member  from  the  Council  on  Medical  Legis- 
lation, to  present  to  the  medical  profession  the 
conditions  under  which  the  widow  of  Major 
James  Carroll  is  now  placed,  and  to  devise  such 
plans  as  might  seem  advisable  for  her  relief.  The 
following  committee  was  appointed:  Major  M. 
W.  Ireland,  U.  S.  A. ;  Surgeon  W.  H.  Bell,  U.  S. 
N,;  Dr.  John  F.  Anderson,  U.  S.  Public  Health 
and  Marine  Hospital  Service ;  Dr.  John  D. 
Thomas,  Washington,  D.  C,  and  Dr.  A.  S.  Von 
Mansfelde,  of  Ashland,  Nebraska. 

Mrs.  Carroll  has  been  granted  a  pension  of 
$125  a  month  on  which  to  support  herself,  seven 
young  children  and  the  aged  mother  of  her  hus- 
band. The  house,  which  Major  Carroll  had 
partly  paid  for,  is  mortgaged  for  $5,000.  Since 
the  conference  adjourned  the  medical  officers  of 
the  Army  have  raised  enough  to  pay  the  taxes  on 
the  house,  one  monthly  note  of  $50  and  the  over- 
due interest  on  the  first  mortgage,  amounting  to 
$125.  Believing  that  the  members  of  the  medical 
profession  will  wish  to  contribute  toward  a  fund 
for  the  purpose  of  paying  the  balance  due  on  the 
house,  the  committee  requests  contributions  of 
any  amount.  They  may  be  sent  to  Major  M.  W. 
Ireland,  United  States  Army,  Washington,  D.  C. 
The  editors  of  The  Bulletin  sincerely  hope  our 
alumni  will  honor  the  memory  of  our  most  dis- 
tinguished alumnus  by  contributing  liberally  to 
this  most  worthy  cause. 


At  the  last  regular  meeting  of  the  University 
of  Maryland  Medical  Association,  held  in  the  am- 
phitheatre of  the  University  Hospital,  Tuesday, 
March  16,  1909,  the  program  was  as  follows: 
1,  "The  General  Practitioner:  His  Relation  to  His 
Patients,  to  His  Fellow  Practitioners  and  to  the 
Community  in  Which  He  Lives,"  Dr.  Guy  Steele, 
Cambridge,  Md. ;  2,  "Medical  Ethics,"  Dr.  Sam- 
uel C.  Chew.  Dr.  A.  M.  Shipley,  the  president, 
was  in  the  chair,  and  called  the  meeting  to  order 
promptly  at  8.30  P.  M.  The  attendance  was 
large  and  appreciative,  and  listened  to  two  re- 
markably able  addresses.  Those  who  had 
the  privilege  and  pleasure  of  listening  to  the 
words  of  wisdom  and  advice  both  of  Dr.  Chew 


38 


THE   HOSPITAL   BULLETIN 


and  Dr.  Steele  went  away  with  a  clearer  concep- 
tion of  their  duties  to  their  professional  brethren 
and  the  public. 

Immediately  after  the  adjournment  of  the 
Medical  Association  the  Adjunct  Facvdty,  with 
its  president.  Dr.  Joseph  W.  Holland,  in  the  chair, 
held  a  very  important  meeting,  the  gist  of  which 
is  as  follows:  Resolved  by  the  Adjunct  Faculty 
of  the  Medical  Department  of  the  University  of 
Maryland  that  the  Board  of  Regents  be  implored 
to  effect  such  changes  in  the  charter  as  to  make 
possible  the  election  of  a  president  with  a  fixed 
salary,  and  with  the  duties  usually  associated 
with  that  office  in  standard  universities,  and  a 
Board  of  Administrators  independent  of  teaching 
faculties.  The  Adjunct  Faculty  also  endorsed 
tentative  plans  looking  towards  the  formation  of 
an  advisorv  board  of  alumni  counsellors. 


At  the  meeting  of  the  Section  on  Opthalmology 
and  Otology,  Thursday,  March  n,  1909,  at  the 
Faculty  Hall,  the  following  of  our  alumni  read 
papers:  "Rodent  Ulcer  of  the  Cornea  (Ulcus 
Rodens  Mooren),  with  Exhibition  of  the  Case," 
Dr.  R.  L.  Randolph;  "Purulent  Otitis  Media  of 
Infancy  and  Childhood,"  Dr.  H.  O.  Reik. 


At  the  meeting  of  the  Section  on  Neurology 
and  Psychiatry,  Friday,  March  12,  1909,  the  fol- 
lowing participated:  "History  and  Forms  of 
Chorea,"  Dr.  N.  M.  Owensby;  "Etiology  of 
Chorea,"  Dr.  H.  D.  McCarty;  "Treatment  of 
Chorea,"  Dr.  W.  S.  Carswell. 


The  Baltimore  Star  of  March  27th,  1909,  has 
this  to  say  concerning  Prof.  Randolph  Winslow: 
"Prof.  Randolph  Winslow,  head  of  the  Depart- 
ment of  Surgery  of  the  University  of  Maryland, 
is  one  of  the  best-known  lecturers  and  demon- 
strators in  the  East.  He  is  a  close  student,  and 
has  the  faculty  of  impressing  the  young  men  of 
the  University  with  the  force  of  and  practicability 
of  his  knowledge.  Professor  Winslow  stands 
high  in  medical  and  surgical  circles  of  the  coun- 
try, and  ranks  with  the  best  surgeons."  Under 
the  caption  of  the  leading  men  of  Maryland  The 
Star  also  included  a  photograph  of  Professor 
Winslow.  By  honoring  Dr.  Winslow  The  Star 
also  honors  the  University  of  Maryland,  whose 
authorities  feel  a  natural  pride  in  the  eminent  po- 
sition held  by  its  professors. 

Dr.  Fitz  Randolph  Winslow,  class  of  1906,  a 
former  resident  physician  in  the  University  Hos- 
pital, and  a  resident  of  Baltimore,  has  located  at 
Hinton,  Virginia. 


The  Phi  Sigma  Kappa  Fraternity  had  an  at- 
home  Saturday,  March  27,  1909. 


About  sixty  members  of  the  Theta  Nu  Ep- 
silon  Fraternity,  University  of  Maryland,  at- 
tended a  banquet  at  the  Belvedere  recently.  It 
was  served  in  the  main  hall,  and  the  tables,  which 


formed  a  semicircle,  were  beautifully  decorated 
with  trailing  asparagus  and  cut  flowers.  During 
the  meal  a  string  orchestra  rendered  popular  se- 
lections. Dr.  Arthur  M.  Shipley,  toastmaster, 
introduced  Mr.  Frederick  W.  Rankin,  who  made 
the  address  of  welcome.  Mr.  Rankin  was  fol- 
lowed by  Dr.  C.  H.  Richards,  who  responded  to 
the  toast  "Past  and  Present;"  Dr.  W.  D.  Scott 
had  as  his  subject  "The  Fraternity  Man;"  Dr. 
R.  Dorsey  Coale,  "The  Undergraduate :"  Dr. 
Randolph  Winslow,  "The  Near  Doctor;"  Dr. 
John  C.  Hemmeter,  "Our  University,"  and  Mr. 
C.  B.  Mathews,  "The  Ladies."  The  reception 
committee  in  charge  of  the  arrangements  was  as. 
follows:  Frederick  W.  Rankin,  chairman;  Ross 
S.  McElwee ;  John  W.  Robertson,  John  S.  Man- 
digo,  Arthur  L.  Fehsenfeld,  J.  F.  Anderson. 


DEATHS. 


Dr.  Joseph  R.  Owens,  class  of  1859,  mayor  of 
Hyattsville,  Md.,  and  treasurer  of  the  Maryland 
Agricultural  College,  died  at  his  home,  in  Hy- 
attsville, March  15,  1909,  after  a  lingering  illness 
of  six  months.  Death  came  peacefully,  and  at 
the  bedside  were  his  wife,  who  was  Miss  Ger- 
trude E.  Councilman,  of  Worthington  Yalley,- 
Baltimore  county,  Md. ;  his  daughter,  Mrs.  Geo. 
B.  Luckey,  and  his  son,  Charles  C.  Owens,  of 
New  York.  Besides  these  he  is  survived  by  his 
mother,  Mrs.  Percilla  Owens,  90  years  of  age ;  a 
son,  Mr.  L.  Owens,  of  New  York,  and  a  daugh- 
ter, Mrs.  A.  A.  Turbeyne,  of  England. 

Dr.  Owens  was  born  in  Baltimore,  February 
20,  1839,  and  was  70  years  old.  His  parents  re- 
moved to  West  River  when  he  was  seven  years 
of  age.  When  he  was  ten  years  old  he  entered 
Newton  Academy,  Baltimore,  and  in  1859  was 
graduated  from  the  Medical  Department  of  the 
University  of  Maryland.  Immediately  after  leav- 
ing the  University  he  was  appointed  resident 
physician  at  the  Baltimore  City  Almshouse,  and 
served  in  this  capacity  to  1861,  when  he  returned 
to  Anne  Arundel  county  and  began  farming  on 
West  River.  In  1885  he  removed  to  Hyattsville 
-uand  accepted  the  position  of  clerk  of  the  Claims 
Division  of  the  Treasury  Department,  Washing- 
ton. He  held  this  office  until  1890,  when  he  was- 
named  as  treasurer  of  the  Maryland  Agricultural 
College,  which  position  he  filled  until  death.  For 
several  years  Dr.  Owens  was  collector  of  taxes  in. 
Anne  Arundel  county.  When  the  municipal  gov- 
ernment of  Hyattsville  was  changed  from  a  board 
of  commissioners  to  a  mayor  and  common  coun- 
cil, Dr.  Owens  was  elected  councilman  from  the 
Third  ward,  and  served  with  marked  ability  until 
May,  1906,  when  he  was  elected  mayor. 

He  was  elected  for  three  consecutive  terms 
without  opposition,  and  was  foremost  in  every 
move  tending  to  the  advancement  of  the  town. 
As  treasurer  of  the  [Maryland  Agricultural  Col- 
lege he  became  acquainted  with  many  of  the  lead- 
ing men  of  the  State,  by  whom  he  was  held  in  the 


THE  HOSPITAL  BULLETIN 


39 


highest  esteem.  He  was  secretary  of  the  Vans- 
ville  Farmers'  Club  for  many  years,  a  director 
of  the  First  National  Bank  of  Hyattsville.  Inter- 
ment was  in  the  cemetery  adjoining  Old  St. 
James'  Protestant  Episcopal  Church,  near  West 
River  Anne  Arundel  county.  The  coffin  was 
home  from  his  late  residence,  Hill  Top  Lodge, 
by  seven  cadets  of  the  Agricultural  College — 
Cadet-Major  Mayor,  Captains  Burrough  and  Jas- 
sell,  Lieutenant  Jarrell  and  Sergeants  Freere, 
Saunders  and  Cole.  A  squad  of  25  cadets,  five 
from  each  class  of  the  College,  under  command 
■of  Captain  Gorsuch,  escorted  the  body  to  Pinkey 
Memorial  Church,  where  the  Episcopal  burial 
service  was  read  by  Rev.  Henry  Thomas,  rector 
-of  St.  Matthew's  Parish,  of  which  Dr.  Owens 
had  been  registrar  and  a  member  of  the  vestry 
for  several  years.  The  body,  preceded  by  the 
college  cadets,  was  taken  to  the  Chesapeake 
Beach  Railway  Station  and  shipped  to  Lyons 
Creek,  and  thence  to  St.  James'  Church.  Rev. 
Henry  Thomas  officiated  at  the  grave.  The  pall- 
bearers were:  Messrs.  Wirt  Harrison,  Harry  W. 
Dorsey,  E.  B.  Owens,  O.  H.  Carr,  T.  Sellman 
.Hall  and  E.  A.  Fuller.  A  special  meeting  of  the 
Mayor  and  Common  Council  was  held  in  Hepta- 
sophs'  Hall  March  22,  1909,  to  take  action  upon 
the  death  of  Dr.  Joseph  R.  Owens,  late  Mayor  of 
Hyattsville.  Acting  Mayor  John  Fainter  Jr.,  was 
chairman  and  Town  Clerk  G.  H.  Carr  was  secre- 
tary. Former  Mayor  Dr.  C.  A.  Wells  eulogized 
the  late  Mayor,  both  as  a  public  official  and  a  pri- 
vate citizen.  Dr.  Joseph  A.  Mudd,  W.  P.  Magru- 
der,  R.  E.  White,  J.  \V.  Aman  and  Edward  Dev- 
lin, all  members  of  the  Council  who  served  with 
Dr.  Owens,  and  R.  W.  Wells,  M.  J.  Smith  and 
S.  J.  Kelly,  the  last  named  as  members  of  the 
present  Council,  also  made  appropriate  addresses. 
It  was  resolved  that  in  the  passing  away  of  Dr. 
Joseph  R.  Owens,  Mayor  of  Hyattsville,  we  have 
lost  a  conscientious  official,  a  valued  associate  and 
a  personal  friend,  and  the  citizens  of  Hyattsville 
at  large,  as  well  as  his  official  associates,  have  ex- 
perienced a  bereavement,  the  effects  of  which 
they  will  ever  feel. 


Dr.  Asa  S.  Linthicum.  class  of  1852,  a  former 
member  of  the  Board  of  County  Commissioners 
of  Anne  Arundel  county,  died  at  his  home,  in 
Jessup,  Mi,  Sunday,  March  28,  1909,  from  apo- 
plexy, aged  78.  About  25  years  ago  Dr.  Linthi- 
cum retired  from  the  active  practice  of  medicine 
to  engage  in  iron  ore  mining. 

Dr.  Linthicum's  wife,  who  died  about- five 
years  ago,  was  Miss  Nettie  Crane,  of  Clifton 
Springs,  N.  J.  Interment  was  in  Loudon  Park 
Cemetery,  Baltimore. 


Dr.  John  Bailey  Mullins,  class  of  1887,  of 
Washington,  D.  O,  a  member  of  the  American 
Medical  Association  and  the  American  Society  of 
Laryngocology  and  Otology,  formerly  of  Nor- 
folk, Ya.,  died  at  his  home,  in  Washington,  D. 


C,  from  cerebral  hemorrhage,  February  11,  1909, 
aged  42. 

Resolutions  on  the  death  of  Dr.  John  Bailey 
Mullins : 

Whereas,  It  has  been  God's  purpose  to  sud- 
denly call  hence  one  of  our  most  useful  and  be- 
loved members ;  be  it 

Resolved,  By  the  Washington  Branch  of  the 
General  Alumni  Association  of  the  University  of 
Maryland,  that  we  are  deeply  grieved  by  the  pre- 
mature death  of  our  honored  associate.  By  his 
death  the  public,  especially  those  worthy  of  char- 
ity, whom  he  was  ever  ready  to  serve,  have  lost  a 
most  useful  citizen,  the  medical  profession  a 
skilled  and  painstaking  physician  and  surgeon, 
and  the  University  of  Maryland  an  able  and  ac- 
tive worker.    And  be  it  further 

Resolved,  That  the  sympathy  of  this  Associa- 
tion be  extended  to  his  daughter,  whom  he  loved 
before  all  else  on  earth,  and  to  whom  he  was  ever 
a  dutiful  father.    And  be  it  further 

Resolved,  That  these  resolutions  be  spread 
upon  the  minutes  of  our  Association  and  a  copy 
of  the  same  be  sent  to  the  parent  Alumni  Asso- 
ciation in   Baltimore. 

Committee — I.  S.  Stone,  William  L.  Robbins, 
Harry  Hurtt.  Monte  Griffith,  president:  W.  M. 
Simpkins,  secretary. 


Dr.  Samuel  Groome  Fisher,  class  of  1854.  of 
Port  Deposit,  Md.,  died  at  the  home  of  his  son, 
in  Port  Deposit,  February  22,  1900.  aged  "/J.  For 
mure  than  50  years  Dr.  Fisher  was  a  practitioner 
of  Chestertown,  Md. 

Dr.  Charles  Brewer,  class  of  1855,  of  Vineland, 
N.  J.,  died  at  his  home,  in  Vineland,  March  3, 
1909,  aged  76.  From  1858  to  the  outbreak  of 
the  Civil  War  he  was  a  member  of  the  Medical 
Corps  of  the  Army,  and  during  the  war  a  surgeon 
in  the  Confederate  States  service.  Under  Presi- 
dent Cleveland  he  was  postmaster  at  Vineland, 
N.  J.,  and  resident  physician  at  the  State  Prison, 
Trenton,  from  1891  to  1896. 


Dr.  William  F.  Chenault,  class  of  1888,  of 
Cleveland,  N.  C,  a  member  of  the  Medical  So- 
ciety of  the  State  of  North  Carolina,  died  at  his 
home,  in  Cleveland,  N.  C,  February  24,  1909, 
from  cerebral  hemorrhage,  aged  46. 


Dr.  James  B.  R.  Purnell,  class  of  1850,  of 
Snow  Hill.  Maryland,  died  at  his  home,  in  Snow 
Hill,  March  7,  1909,  from  senile  debility,  aged  80. 
He  was  vice-president  of  the  Medical  and  Chirur- 
gical  Faculty  of  Maryland  in  1900-1901,  formerly 
physician  to  the  county  almshouse  and  health  of- 
ficer of  Worcester  county. 


Dr.  Benjamin  Franklin  Laughlin,  class  of 
1904,  of  Kingwood,  West  Virginia,  died  at  the 
home  of  his  father,  in  Deer  Park,  Md.,  from 
paralysis,  March  9,  1909,  aged  31. 


IN   PNEUMONIA   the    inspired    air   should    be   rich    in    oxygen   and    ccm- 
paratively   cool,    while    the    surface    of    the    body,    especially    the   thorax, 
should  ba  kept  warm,  lest,  becoming   chilled,  the  action  of  the  phagocytes 
in  their  battle  with  the  pneumococci  be  inhibited. 


(Inflammation's  cAniidote) 

applied  to  the  chest  wall,  front,  sides  and   back,    hot    and  thick,  stimulates  the 
action  of  the  phagocytes  and  often  turns  the  scale  in  favor  of  recovery. 

Croup. —  Instead  of  depending  on  an  emetic  for  quick  action  in 
croup,  the  physician  will  do  well  to  apply  Antiphlogistine  hot  and  thick  from 
ear  to  ear  and  down  over  the  interclavicular  space.  The  results  of  such  treat- 
ment are  usually  prompt  and  gratifying. 

Antiphlogistine  hot  and  thick  is  also  indicated  in  Bronchitis  and  Pleurisy 


The   Denver  Chemical   Wlfg.  Co. 


New  York 


ERTAIN  as  it  is  that  a  single  acting  cause  can  bring 
about  any  one  of  the  several  anomalies  of  menstrua- 
tion, just  so  certain  is  it  that  a  single  remedial  agent 
—  if  properly  administered  —  can  effect  the  relief  of 
any  one  of  those  anomalies. 

t]|  The  singular  efficacy  of  Ergoapiol  (Smith)  in  the 
various  menstrual  irregularities  is  manifestly  due  to  its  prompt 
and  direct  analgesic,  antispasmodic  and  tonic  action  upon  the 
entire  female  reproductive  system. 

<J  Ergoapiol  (Smith)  is  of  special,  indeed  extraordinary,  value  in 
such  menstrual  irregularities  as  amenorrhea,  dysmenorrhea, 
menorrhagia  and  metrorrhagia. 

1§  The  creators  of  the  preparation,  the  Martin  H.  Smith 
Company,  of  New  York,  will  send  samples  and  exhaustive 
literature,  post  paid,  to  any  member  of  the  medical  profession, 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 

PRICE    $1.00    PER    YEAR 

Contributions  invited  from  the  Alumni  of  the  University.  Entered  at  the  Baltimore  Post-office 

Business  Address,  Baltimore,  Md.  as  Second  Class  Matter. 


Vol.  V 


BALTIMORE,  MD.,   MAY  15,   1909 


No.  3 


THREE  ESOPHAGEAL  CASES. 
By  Richard  H.  Johnston,  M.  D., 

Lecturer  on  Laryngology  in  the  University  of 
Maryland,  Surgeon  to  the  Presbyterian 
Hospital,  Baltimore. 
The  esophagoscope  has  passed  the  experimen- 
tal stage  in  the  diagnosis  and  treatment  of  esoph- 
ageal lesions.  Its  usefulness  has  been  demon- 
strated so  often  that  it  would  seem  superfluous 
to  dilate  upon  its  value.  Its  use.  however,  is  not 
as  general  as  it  should  be.  There  are  still  those 
who  consider  esophagoscopy  unnecessary  or  im- 
practicable. At  the  Presbyterian  Hospital  we 
have  had  numerous  instances  of  its  practicability, 
and  with  us  it  has  become  the  routine  practice  to 
examine  all  patients  complaining,  of  obscure 
esophageal  symptoms.  Dr.  Chevalier  Jackson  re- 
cords the  case  of  a  patient  whose  only  symptom 
was  a  lump  on  swallowing.  She  appeared  to  be 
a  neurasthenic,  and  his  advice  to  have  the  esoph- 
agus examined  was  ignored  by  the  family  physi- 
cian. Two  months  later,  with  the  patient  ether- 
ized for  a  radical  antrum  operation,  he  passed 
the  esophagoscope  and  found  a  malignant 
growth. 

Three  interesting  cases  have  recently  come 
under  my  observation,  and  they  illustrate  so  well 
the  value  of  the  esophagoscope  1  shall  report  them 
Somewhat  in  detail.  The  first  patient  was  seen 
with  Dr.  E.  I!.  Freeman;  she  was  67  years  old. 
The  morning  before  she  came  to  the  hospital. 
while  eating  ham.  she  swallowed  a  large  piece 
that  had  not  been  sufficiently  masticated.  It 
lodged  in  the  introitus  esophagi  and  remained 
there.  When  she  came  to  the  hospital  she  had 
swallowed  neither  solid  nor  liquid  food  for  nearly 
thirty-six  hours.  A  half  hour  before  examining 
the  esophagus  she  was  given  a  hypodermic  of 
morphia  and  atropia.  With  the  patient  in  the  sit- 
ting position  the  throat  and  upper  end  of  the 
K  esophagus  were  anesthetized  with  10  per  cent, 
solution  of  cocaine.  Jackson's  laryngeal  specu- 
lum was   introduced  and  the  larynx  pulled   for- 


ward. A  large  mass  resembling  somewhat  an  ul- 
cerative epithelioma  was  seen,  and  proved  to  be 
the  piece  of  ham.  Dr.  Freeman  and  I  removed  it 
piecemeal  with  1'fau's  foreign  body  forceps.  It 
required  about  forty-five  minutes  to  remove  it 
entirely.  The  patient  stood  the  ordeal  well,  and 
was  able  to  go  home  the  same  afternoon.  For 
about  a  week  she  had  temperature,  cough  and 
expectoration,  but  ultimately  made  a  good  recov- 
ery. In  this  ease  the  esophagoscope  probably 
saved  the  patient  an  esophagotomy.  The  second 
patient  was  a  female,  thirty-three  years  old,  re- 
ferred to  me  by  Dr.  J.  F.  Chisolm.  of  Savannah. 
While  at  an  oyster  supper  she  attempted  to  swal- 
low a  large  oyster,  with  the  result  that  she  choked 
for  a  few  seconds  and  then  had  a  sense  id'  fulness 
in  the  region  of  the  larynx.  The  next  day  she 
had  sonic  difficulty  in  swallowing,  so  that  she 
took  only  liquids.  The  second  day  afterward 
swallowing  was  decidedly  painful:  she  grew  rap- 
idly worse,  until  the  fourth  day  her  condition 
was  serious.  She  reached  this  city  the  morning 
of  the  fifth  day,  with  a  temperature  of  100  de- 
grees and  extreme  prostration.  The  examina- 
tion of  the  esophagus  was  made  under  ether  with 
the  head  in  the  extended  position.  No  foreign 
body  was  found,  but  the  upper  end  of  the  esoph- 
agus was  red,  swollen  and  edematous,  and  seemed 
to  be  closed.  The  patient  was  given  cold  milk 
and  ice  bags  to  the  throat.  For  two  days  she 
suffered  excruciating  pain  011  swallowing,  and  it 
looked  as  if  we  would  have  to  resort  to  rectal 
feeding".  The  next  clay  there  was  slight  amelio- 
ration of  the  pain,  which  gradually  disappeared. 
In  this  case  the  esophagoscope  enabled  us  to  see 
at  once  that  a  foreign  body  was  not  present,  and 
that  the  symptoms  were  due  to  a  severe,  acute  in- 
flammation, probably  caused  by  a  piece  of  shell 
attached  to  the  oyster. 

I  was  asked  by  Dr.  A.  M.  Shipley  to  examine 
a  patient  who  had  been  referred  to  him  for  prob- 
able cancer  of  the  stomach.  The  man  was  sixty 
years  old  and  had  had  some  trouble  in  swallow- 
ing for  about  two  months.     Attempts  to  pass  the 


42 


THE   HOSPITAL   BULLETIN 


stomach  tube  were  unsuccessful.  The  patient 
was  examined  in  the  sitting  position  after  cocaine 
anesthetization.  No  difficulty  was  experienced 
in  passing  the  esophagoscope.  About  three 
inches  below  the  cricoid  cartilage  the  progress  of 
the  instrument  was  arrested  by  a  tumor  partially 
closing  the  esophageal  lumen.  The  esophago- 
scope showed  that  the  tumor  was  too  low  for  re- 
moval. In  this  case  the  patient  can  be  dilated 
through  the  esophagoscope  and  made  more  com- 
fortable for  the  short  time  he  has  to  live. 
919  North  Charles  street. 


SYPHILITIC  OSTEOPERIOSTITIS. 

By  C.  G.  Moore,  '09. 

Senior  Medical  Student. 

The  bony  manifestations  of  syphilis  occur  as 
secondary  and  tertiary  lesions,  and  as  Keyes,  of 
New  York,  has  pointed  out,  these  so-called 
"nodes"  are  simply  local  periosteal  congestions, 
accompanied  by  serious  effusions  without  cell  hy- 
perplasia. Any  bone  in  the  body  may  be  affected 
by  syphilis,  but  certain  of  them  suffer  by  prefer- 
ence, such  as  the  thin  bones  of  the  nose  and 
pharynx — that  is,  those  exposed  to  climatic 
changes  and  injuries,  such  as  the  bones  of  the 
skull,  ulna,  tibia,  etc. 

We  must  call  special  attention  to  injur}'  as  a 
powerful  pre-disposing  cause  of  bone  syphilis, 
for,  when  we  consider  that  bone  lesions  may  be 
the  only  manifestations  of  existing  syphilis,  with 
the  presence  of  a  bone  lesion  before  us,  with  an 
antecedent  history  of  an  injury,  we  must  not  for- 
get that  we  may  overlook  the  true  nature  of  the 
disease,  and  hence  must  be  constantly  on  the  alert 
for  the  syphilitic  taint. 

Lancereaux  classified  the  bone  lesions  under 
three  heads,  viz. : 

(a)  Inflammatory  osteo-periostitis. 

(b)  Gummy  tumor  of  bone. 

(c)  Dry  caries,  atrophic  form. 

(1)  Inflammatory  osteo-periostitis  is  the  most 
frequent  form,  and  is  characterized  by  inflam- 
matory phenomena,  vascularization  and  exuda- 
tion of  a  serio-glutinous  material.  It  may  be 
either  diffuse  or  circumscribed,  and  located,  as 
its  name  implies,  in  the  area  of  contact  with  the 
osseous  and  periosteal  surfaces.  The  pain  is 
aching,  acute,  throbbing  or  boring  in  character, 
while  tenderness  upon  pressure  and  percussion  is 
most  exquisitely  excruciating.  The  diagnosis  of 
inflammatory  osteo-periostitis    is    comparatively 


easy,  if  we  remember  the  characteristics,  viz.,  an 
oval,  painful,  boggy  or  even  hard  bony  lesion,  ac- 
companied by  nocturnal  exacerbations  of  pain, 
with  a  concomitant  or  antecedent  history  of  syph- 
ilis. Ostitis  with  parenchymatous  thickening  is 
somewhat  less  positive  in  its  character,  but  with 
nocturnal  pains  which  are  usually  constant. 

(2)  Gummy  tumor  of  bone  develops  either 
under  the  periostum,  in  the  substance  of  bone,  or 
in  the  medullary  canal.  It  is  simply  an  intensifi- 
cation of  the  process  found  in  the  inflammatory 
form  just  described,  the  difference  being  that  the 
cell  hyperplasia  is  more  abundant.  Much  of  the 
new  material  collects  in  a  circumscribed  space, 
and  being  more  rapidly  formed  and  less  capable 
of  organization,  it  entails  more  profound  lesions 
by  its  retrograde  metamorphosis.  Generally  tu- 
mor of  the  bone  is,  therefore,  a  much  more  se- 
rious form  of  disease  than  osteo-periostitis. 

In  the  long  bones  the  medullary  canal  is  the 
usual  seat  of  deposit.  The  bone  becomes  hyper- 
trophicd  in  a  porous  manner,  the  Haversian 
canals  and  canaliculi  become  enlarged  and  filled 
with  a  gummy  material  which  resembles  a  solu- 
tion of  gum  arabic.  In  the  flat  bones,  especially 
the  cranial  bones,  the  cancellar  tissue  is  attacked, 
and  may  cause  a  separation  of  the  two  tables,  and 
often  necrosis  of  one  or  the  other  plates  results. 
If  it  happens  to  be  the  inner  one  which  undergoes 
carious  degeneration,  brain  symptoms  will  de- 
velop. 

(3)  Dry  Caries. — According'  to  Virchow,  dry 
caries  is  always  due  to  syphilis.  This  affection 
is  a  miniature  gummy  ostitis.  Around  one  of  the 
vascular  canals  the  gummy  material  is  deposited, 
this  gummy  material  being  later  absorbed,  leav- 
ing a  stellate  induration.  This  goes  on  leaving  a 
a  funnel-shaped  depression,  its  point  leading  into 
the  diploe,  which  may  be  plainly  appreciated  by 
palpation.  The  essential  features  of  this  caries  is 
the  fact  that  no  sequestra  are  formed,  no  pus  ex- 
truded, nor  is  the  skin  but  rarely  involved. 

The  following  is  a  case  of  syphilis  in  which 
osteo-periostitis  developed : 

On  January  22nd.  1909,  R.  B.,  age  35,  white, 
a  housewife,  applied  to  the  Medical  Department 
of  the  University  Hospital  Dispensary  for  treat- 
ment, complaining  of  rheumatism  in  her  back 
and  a  sore  shin.  The  patient  has  been  married 
14  years  and  has  bad  four  children;  the  two  eld- 
est are  the  only  ones  now  living.  Three  years  ago 
she  gave  birth  to  a  full-term  child  which  only 
lived  a  few  minutes  after  expulsion. 


THE   HOSPITAL   BULLETIN 


43 


One  year  later  she  gave  birth  to  another  child, 
which  was  not  at  full  term,  but  about  six  months 
advanced.  She  says  two  days  previous  to  this 
birth  she  fell  down  stairs  and  struck  on  her  abdo- 
men. When  the  child  was  born  its  thigh  was 
fractured,  and  the  physician  who  attended  her 
said  the  fracture  was  caused  by  the  fall. 

Her  father  died  nine  years  ago,  at  the  age  of 
68  years,  of  apoplexy;  her  mother  was  killed  a 
few  years  ago  in  an  accident.  She  has  two  broth- 
ers and  three  sisters,  all  living  and  in  good  health, 
as  far  as  she  knows.  She  is  at  present  living 
with  her  husband,  and  says  he  is  apparently  well 
and  sound,  but  drinks  heavily,  and  when  under 
the  influence  of  liquor  abuses  her  a  great  deal. 
Patient  denies  ever  having  had  tuberculosis, 
syphilis,  diphtheria,  typhoid,  scarlet  fever,  ma- 
laria, grippe,  gonorrhoea,  or  any  of  the  nervous 
or  malignant  diseases.  She  sometimes  has  a  sore 
throat  when  she  takes  cold,  but  it  only  lasts  a  few 
days.  She  has  complained  of  rheumatism  in  her 
back  and  limbs  for  the  past  three  or  four  years, 
and  thinks  it  is  worse  at  night. 

Patient  never  complained  of  any  trouble  other 
than  those  mentioned  until  three  years  ago,  when 
her  third  child  was  born.  She  says  that  at  that 
time  her  hair  fell  out,  and  an  eruption,  which 
itched  slightly,  broke  out  all  over  her  body,  in- 
cluding her  face,  but  only  extended  down  her 
arms  as  far  as  her  wrists.  This  lasted  a  few 
weeks,  then  seemed  to  subside,  but  never  entirely 
disappeared,  and  when  she  gave  birth  to  the 
still-born  child,  one  year  later,  it  broke  out  again 
worse  than  before.  She  went  to  Dr.  McElfresh, 
who  treated  her  for  about  three  weeks,  giving 
her  some  medicine  to  take  internally,  also  some 
sulphur  ointment.  She  for  a  time  got  some  bet- 
ter, but  owing  to  her  circumstances  was  unable 
to  continue  treatment  with  Dr.  McElfresh,  and 
has  done  nothing  for  her  condition  until  the  pres- 
ent time.  For  the  past  four  months  she  has  been 
suffering  with  a  pain  in  her  right  shin ;  this  has 
been  gradually  getting  worse,  and  one  week  ago 
began  to  swell  and  cause  her  considerable  pain, 
being  worse  at  night,  and  sometimes  hurting 
her  so  much  that  she  is  unable  to  sleep,  hence  her 
reason  for  coming  to  the  dispensary. 

Upon  questioning  her  in  regard  to  her  general 
health,  she  says  she  feels  as  well  as  she  ever  did, 
with  the  exception  of  the  previously  mentioned 
pain. 


Her  appetite  and  digestion  are  good,  and  her 
bowels  are  regular,  and  she  has  no  lung,  heart  or 
kidney  trouble.  She  has  had  no  headaches, 
nausea,  or  vomiting,  and  her  menstrual  periods 
have  always  been  regular  and  painless. 

Upon  examining  patient  I  found  her  to  be  well 
nourished  and  well  developed,  weighing  142 
pounds.  Her  color  was  good  and  her  pupils  about 
normal  in  size,  reacting  to  light  and  accommoda- 
tion. Both  patella  reflexes  were  absent,  also 
Romberg's  sign,  and  there  was  no  enlargement 
of  the  mastoid,  epitrochlear,  post-cervical  or  in- 
guinal glands.  Her  pulse  was  84  to  the  minute, 
regular  in  rate  and  force.  The  tension  and 
volume  was  good;  her  temperature  was  98.6°. 
Her  heart  was  normal  in  size,  and  on  auscultation 
the  sounds  were  clear  and  no  murmurs  were 
heard.  The  expansion  of  both  lungs  was  good, 
the  respirations  being  20  to  the  minute. 

Percussion  and  auscultation  were  negative ;  all 
the  abdominal  organs  seemed  to  be  normal.  There 
was  an  ecchymotic  area  under  her  left  eye,  which 
she  says  was  caused  by  her  husband  striking  her 
two  years  ago  when  intoxicated. 

There  was  a  circular  reddish  macular  papular, 
non-itching  eruption  which  does  not  disappear  on 
pressure,  varying  from  the  size  of  a  bird  shot  to 
that  of  a  nickel,  and  is  confined  to  her  back,  chest, 
shoulders  and  arms,  most  profuse  on  the  left  side, 
and  is  not  seen  on  the  lower  limbs  at  all.  On  her 
left  shoulder  some  of  these  lesions  have  devel- 
oped into  pustules,  which  have  become  infected 
and  slightly  ulcerated ;  these  give  her  slight  pain. 

In  the  corner  of  her  mouth  is  a  scar  which 
looks  like  the  initial  sign  of  lues,  but  she  claims 
it  appeared  a  few  weeks  after  the  breaking  out 
on  her  body.  On  examining  her  mouth  no  mu- 
cus patches  or  scars  were  found. 

She  now  has  an  osteo-periostitis  on  the  anterior 
aspect  of  her  right  tibia.  It  is  moderately 
swollen,  slightly  reddened,  and  is  very  painful 
(the  pain  is  aching,  acute  and  boring  in  charac- 
ter) on  pressure,  and  on  tapping  the  bone  with 
my  finger  above  and  below  this  point  it  caused 
her  intense  pain.  (Patient  claims  she  has  never 
received  any  injury  in  this  location.) 

Upon  consulting  Dr.  McElfresh,  he  remem- 
bered the  case  and  said  that  he  had  treated  her 
for  a  short  time  about  two  years  ago  for  the  in- 
itial symptoms  of  syphilis,  but  since  then  has 
never  seen  her. 


44 


THE   HOSPITAL   BULLETIN 


She  is  now  receiving-  the  mixed  treatment  of 
protiodid  of  mercury,  gr.  )/\,  with  a  saturated  so- 
lution of  potassium  iodid  three  times  a  day,  start- 
ing her  on  ten  drops,  then  increasing  it  one  drop 
each  time  taken.  I  requested  her  to  return  when 
the  medicine  is  finished. 


DISCUSSION  BY  DR.  WARNER  HOLT,  OF 
WASHINGTON,  OF  THE  PAPER  ON 
THE  CHEMICAL  CO-RELATION  BE- 
TWEEN THE  SALIVARY  GLANDS  AND 
THE  STOMACH,  BY  JOHN  C.  HEM  ME- 
TER, OF  BALTIMORE. 

Read  Before  the  Society  for  Experimental  Biol- 
ogy and  Medicine,  of  New  York,  Meeting  in 
the  Rockefeller  Institute  for  Medical  Research. 
on  December  if),  1908. 

Dr.  Holt  said  in  part :  "This  experimental 
study  by  Dr.  Hemmeter  is  not,  as  it  might  appear 
to  be,  only  an  inquiry  into  the  physiology  of  a 
limited  part  of  the  digestive  apparatus,  but  it  is 
an  attempt  to  solve  a  biologic  problem  and  to  get 
at  the  broad  basic  principles  that  underlie  the 
chemical  co-relation  of  the  organs. 

"When  a  worker  occupies  himself  with  the  ef- 
fect of  the  extirpation  of  one  organ  of  digestion 
upon  the  organs  in  the  next  segment  of  the  di- 
gestive apparatus,  he  naturally  thinks  of  phe- 
nomena of  exclusion  or  loss  of  function  in  one  or 
the  other  of  the  segments  following  the  one  ex- 
tirpated, but  instead  of  phenomena  of  exclusion 
it  is  conceivable  that  those  of  exaggerated  activ- 
ity in  the  other  segments  of  the  digestive  tube 
might  result. 

"For  'a  priori'  we  cannot  know  whether  the  in- 
fluence that  one  segment  of  the  digestive  tract 
exerts  upon  the  succeeding  segment  is  that  of 
stimulation  or  of  inhibition,  or  of  both,  viz.,  of 
stimulation  under  one  set  of  conditions  and  inhi- 
bition under  another  set  of  conditions.  In  the 
investigation  of  the  problem  of  a  chemical  co-re- 
lation between  the  salivary  glands  and  the  stom- 
ach, Dr.  Hemmeter  has  done  meritorious  work,  a 
great  part  of  which  it  has  been  my  good  fortune 
to  observe  and  assist  in  personally :  though  I  am 
a  physician  in  the  employment  of  the  government 
at  Washington,  I  consider  myself  a  post-graduate 
student  of  Professor  Hemmeter.  I  have  seen 
personally  four  of  his  animals  that  had  success- 
fully been  nursed  through  the  Pawlow  operation 
and  extirpation  of  the  salivary  glands  after 
months  of  the  most  trying  work.     It  required  a 


great  deal  of  perseverance  to  persist  in  this  kind 
of  work,  especially  when  some  of  the  best  ani- 
mals that  had  emerged  safely  from  the  vicissi- 
tudes of  the  operation  for  an  accessory  stomach 
and  from  the  removal  of  all  the  salivary  glands 
on  one  side  of  the  head  succumbed  to  the  third 
operation  in  the  attempt  to  remove  the  remaining 
salivary  glands  on  the  other  side. 

"The  history  of  these  operative  failures,  though 
they  will  never  be  told,  constitute  a  large  part  of 
the  merit  of  those  who  have  worked  with  Dr. 
Hemmeter  in  this  research.  No  matter  what  the 
final  outcome  of  the  future  investigation  of  this 
problem  will  be,  whether  affirmative  or  negative, 
the  intrinsic  value  of  such  work  will  be  appre- 
ciated by  all  who  are  to  the  least  degree  conver- 
sant with  the  history  of  physiology.  Nowadays 
we  are  too  liable  to  forget  the  hard  plodders  in 
experimental  work  who  have  started  the  solution 
of  a  problem,  and  when  the  last  word  has  been 
said  the  worker  of  the  beginning  is  generally  for- 
gotten. 

"In  this  connection  I  desire  to  quote  an  expres- 
sion of  Prof.  William  II.  Welch  concerning  the 
merit  of  the  work  of  ex-Surgeon  General  Stern- 
berg, done  since  the  first  Yellow  Fever  Commis- 
sion was  appointed,  in  1879  (see  Medical  News. 
June  21,  1902.  p.  1198).  Dr.  Welch  said  'that, 
Sternberg's  work  with  yellow  fever  would  stand 
forever ;  that  it  was  a  common  thing  in  these 
busy  days  to  forget  the  steps  which  led  up  to  an 
important  discovery.  All  that  Dr.  Sternberg  had 
done  in  the  study  of  yellow  fever  was  necessarv 
work,  and  it  had  to  be  done  just  in  the  way  that 
he  did  it.  The  ground  had  first  to  be  cleared.  If 
it  were  not  so,  the  discovery  had  not  been  pos- 
sible ;  and  later  discoverers  themselves  would 
have  had  to  hunt  out  the  large  host  of  microor- 
ganisms which  Dr.  Sternberg  had  described  and 
laid  aside.' 

"And  similarly  I  can  say  of  Dr.  Hemmeter 's 
efforts  that,  no  matter  what  the  eventual  outcome 
of  this  problem  will  be,  all  that  he  has  done  was 
necessary  work,  and  it  had  to  be  done  just  in  the 
way  that  he  did  it. 

"Just  one  more  idea  and  I  shall  have  finished. 
It  concerns  the  demonstration  of  such  research 
work  in  places  at  a  distance  from  the  experiment- 
or's  laboratory.  Such  demonstrations  are  always 
attended  with  great  difficulty.  They  usually  re- 
quire four  animals,  two  or  three  janitors  to  trans- 
port them,  and  as  many  laboratory  assistants  as 


THE   HOSPITAL   BULLETIN 


45 


the  director  of  the  laboratory  can  manage  to  take 
with  him.  The  technique  of  these  operations,  the 
high-grade  sensitiveness  of  operated  animals,  the 
refinement  with  which  chemical  tests  should  be 
made,  all  require  for  their  safe  conduct  that  the 
experimentor  should  work  only  with  those  men 
who  are  used  to  his  system.  The  animals  them- 
selves are  always  influenced  in  one  way  or  other 
by  the  presence  of  strangers.  I  remember  in  one 
animal  which  was  demonstrated  on  March  17th. 
at  the  University  Hospital,  the  demonstration  at 
which  Dr.  Satterthwaite  was  present,  a  most  un- 
expected change  in  the  quality  of  the  gastric  se- 
cretions took  place.  This  was  a  control  animal 
which  had  undergone  no  operation  whatever.  He 
was  simply  taken  along  to  show  the  proteolytic 
power  of  a  normal  dog  and  compare  it  with  the 
operated  dogs.  His  gastric  juice  had  been  pre- 
viously tested  on  several  occasions,  and  always 
found  to  be  of  regular  standard,  but  on  the 
night  of  the  demonstration  before  the  .Medical 
Society  this  animal's  gastric  juice  was  practically 
inactive,  containing  no  HCL  nor  pepsin. 

"Dr.  Hemmeter  has  already  informed  you  that 
in  some  animals  the  loss  of  gastric  juice  after  ex- 
tirpation of  the  salivary  glands  is  only  temporary, 
and  that  in  varying  time — in  some  cases  three 
weeks,  in  other  animals  three  to  four  months — 
there  is  a  gradual  resumption  of  gastric  secretion. 
This  resumed  secretion,  however,  never  becomes 
as  effective  as  it  was  in  the  same  dog  before  an 
operation.  The  question  when  to  begin  to  make 
observations  on  an  operated  animal  depends  en- 
tirely upon  the  state  of  this  animal;  if  the  dog 
eats  his  food  with  appetite  he  has  no  fever,  and 
his  digestion  appears  to  be  satisfactory :  then  the 
observations  may  be  begun,  even  if  it  is  only  one 
week  or  ten  days  after  the  last  operation.  (  )ne 
of  the  most  valuable  animals  that  was  used  in 
this  series  of  experiments  was  so  injured  in  the 
effort  to  transport  him  to  another  laboratory  that 
he  could  not  be  used  for  further  experimentation. 
The  dog  struggled  so  in  his  holder  while  he  was 
being  transported  in  a  wagon  that  the  partition  of 
true  mucosa  which  separates  the  accessory  from 
the  plain  stomach  was  broken  through.  This  had 
happened  once  before  in  transporting  a  dog  from 
the  laboratory  to  Dr.  Hemmeter's  country  place, 
and  his  associates  in  the  Medical  Faculty,  becom- 
ing aware  of  the  great  labor  and  cost  involved  in 
such  operations,  and  the  rarity  with  which  they 
succeed,  advised  that  no  further  Paw  low  dogs  be 
sent  to  other  laboratories." 


AN   INTERESTING  CASE  OF  SCROTAL 
HERNIA. 

By  G.  E.  Bennett,  '09. 

Senior  Medical  Student. 

Patient — Ge<  irge  Kolubaher. 

Age — Sixty-six  years. 

Occupation — At  present  a  farmer:  formerly 
worked  as  laborer  in  stone  quarry. 

Complaint — Patient  entered  the  hospital  on 
January  21,  1909,  complaining  of  great  pain  and 
discomfort  in  the  right  inguinal  region  and  in  the 
scrotum  of  the  same  side. 

Physical  Examination — Inspection  showed  an 
enormously  enlarged  scrotum,  more  marked  on 
the  right  side,  and  a  prominent  swelling  along  the 
right  inguinal  canal,  which  was  most  marked 
when  standing.  Marked  discoloration  on  the 
skin  of  the  scrotum  and  inner  side  of  both  thighs, 
probably  due  to  use  of  counter-irritants. 

Palpation — Mass  soft  and  freely  movable, 
showing  no  skin  attachments  ;  slight  impulse  on 
coughing.  Slightly  painful  on  pressure.  Some 
gurgling  when  manipulated. 

Percussion — Slightly  tympanitic. 

Remarks — Contents  of  the  sacs  were  forced 
into  abdominal  cavity  after  prolonged  manipula- 
tion, returning  to  original  condition  as  soon  as 
pressure   was  taken   away. 

History  of  patient  shows  nothing  of  interest 
except  that  of  the  present  condition,  which  began 
suddenly  twenty  years  ago.  While  lifting  a 
heavy  block  of  stone  had  a  feeling  as  though 
something  had  "given  away"  in  his  right  side. 
This  sensation  was  immediately  followed  by  one 
of  intense  pain  and  general  discomfort.  The  day 
following  the  patient  noticed  a  small  lump  in  the 
right  inguinal  region  that  disappeared  on  pres- 
sure, returning  when  he  lifted  any  heavy  object. 

For  eighteen  years  the  condition  gave  him  no 
serious  discomfort  except  for  the  wearing  of  a 
truss  and  becoming  larger.  Two  years  ago  the 
truss  was  discarded  as  being  useless. 

One  week  ago  conditions  grew  suddenly  worse, 
and  patient  was  confined  to  bed.  Has  suffered  a 
great  deal  of  pain  and  has  been  unable  to  sleep. 

On  Januarv  22,  1909.  patient  was  operated 
upon  by  Professor  Winslow.  Operation  as  fol- 
lows : 

Patient  was  brought  to  the  operating  room  at 
11.30  A.  M.,  anesthetized  and  prepared  for  an 
aseptic  operation. 


46 


THE   HOSPITAL   BULLETIN 


Incision  about  five  inches  in  length  was  made 
parallel  to  Pouparts  ligament  and  immediately 
over  the  inguinal  canal,  passing  through  the  skin 
and  subcutaneous  fat.  The  external  ring  having 
been  exposed  a  grooved  director  was  passed  into 
same,  passing  under  the  aponeurosis  of  the  ex- 
ternal oblique  muscle;  fibers  of  same  were  split, 
using  the  director  as  a  protective  guide.  The 
sac  was  exposed  and  carefully  dissected  free 
from  its  surrounding  tissues,  and  upon  examina- 
tion was  found  to  be  continuous  with  the  cover- 
ing of  the  testacle  (giving  the  appearance  of  a 
congenital  hernia).  The  sac  was  next  opened 
and  found  to  contain  small  intestines  and  a  Meck- 
el's diverticulum.  Following  this  the  intestines 
were  replaced  in  the  abdominal  cavity.  Digital 
examination  through  the  internal  ring  showed  the 
bladder  to  be  adherent  to  the  peritoneum  at  the 
margin  and  toward  the  median  line.  The  sac  was 
tied  close  to  the  internal  ring,  cut  free.  The 
distal  portions  of  the  sac  were  drawn  upward, 
bringing  the  testacle  into  view ;  sac  was  cut  close 
to  same  and  sutured  so  as  to  enclose  the  greater 
part  of  it. 

The  margins  of  the  internal  oblique  and  trans- 
versalis  muscles  were  sutured  to  Poupart's  liga- 
ment by  a  mattress  suture.  The  aponeurosis 
of  the  external  oblique  was  re-established  into 
normal  position  by  suturing,  and  the  skin  closed 
by  subcutaneous  silver  wire  suture  silk  having 
been  used  for  all  other  sutures. 

Sterile  dressings  were  then  applied  and  card- 
board splints  to  keep  limb  immobile.  Then  ban- 
daged with  crenolin.  The  patient  left  the  operat- 
ing room  at  I  P.  M.  in  good  condition. 

Notes  of  Interest — 

That  a  hernia,  apparently  congenital,  should 
not  have  made  an  earlier  appearance. 

The  presence  of  a  Meckel's  diverticulum  in  the 
sac,  this  being  the  condition  that  gives  rise  to  a 
true  Richter's  hernia. 

That  a  hernia  of  so  large  proportion  should 
have  caused  so  little  trouble  to  the  patient. 

Patient  recovered  in  very  short  time,  leaving 
the  hospital  in  good  condition. 


THE  TEACHING  OF  THE  SPECIALTIES. 

By  Hiram  Woods.  M.  D. 
Read  Before  the  University  of  Maryland  Medi- 
cal Association,  April  21,  1909. 

Teaching   specialties   to    undergraduates    must 
be  carefully  separated  from  the  same  teaching  to 


post-graduate  students.  The  latter  may  be  sup- 
posed to  have  given  such  thought  to  their  future 
career  as  to  have  reached  the  conclusion  that  they 
wish  to  devote  themselves  to  a  certain  line  of 
work.  It  is  not  these  men  whom  I  propose  to 
discuss,  save  to  say,  in  passing,  that  the  average 
six  weeks'  or  two  months'  course  offered  bv  post- 
graduate schools  is  totally  inadequate.  As  a  rule 
such  courses  attract  a  large  number  of  men  who 
do  little  more  than  follow  the  clinical  work  of 
some  well-known  specialist  and  pick  up  what 
they  can.  Either  prolonged  hospital  experience, 
as  interne  or  clinical  assistant,  or  a  special  indi- 
vidual course,  with  a  competent  teacher,  is  needed 
for  a  decent  foundation  in  special  work. 

It  seems  to  me  that  with  undergraduate  work 
the  first  important  step  is  to  secure  the  attention 
of  the  men,  and  convince  them  that  there  is  some- 
thing in  the  special  course  worthy  of  notice. 
There  is  a  state  of  mind,  not  unnatural  to  the 
undergraduate,  regarding  specialties.  Most  of 
them  propose  to  begin  professional  life  as  gen- 
eral practitioners.  They  think  they  will  never 
have  use  for  knowledge  in  the  so-called  special- 
ties, and  that  the  little  they  will  need  in  order  to 
get  a  passing  mark  can  be  easily  crammed  at  the 
close  of  the  session.  As  a  matter  of  fact,  it  is 
easy  to  frame  questions  so  that  this  "crammed" 
information  is  of  little  use,  and  the  most  liberal 
grading  hardly  ever  brings  such  men  up  to  a 
passing  mark.  The  mental  attitude  of  these  men 
is  unjust  to  themselves,  their  teacher  and  the 
patients  who,  in  the  near  future,  will  entrust  to 
them  their  physical  welfare.  The  very  term 
"general  practitioner"  implies  a  general  knowl- 
edge of  medicine.  If  one  lives  in  a  .city,  where 
the  services  of  specialists  are  readily  obtained,  he 
may,  if  he  desires,  refuse  certain  cases,  and  take 
only  such  as  he  wants — say  such  as  belong  to  in- 
ternal medicine.  But  in  so  doing  he  becomes  a 
specialist  himself,  and  if  he  has  neglected  a 
properly  prepared  special  course  for  undergrad- 
uates while  a  student  he  will  miss  information  of 
great  use  to  him  as  an  internist.  Many  men, 
however,  do  not  practice  where  specialists  are 
easily  obtained,  and,  perforce,  must  take  cases 
which  would  logically  come  under  one  or  other 
of  the  recognized  specialties.  Here  is  a  profes- 
sional responsibility  which  it  is  the  aim  and  duty 
of  a  special  teacher  to  enable  his  student  to  meet. 
May  I  illustrate  by  directing  attention  to  two 
troubles  which  it  is  my  own  privilege  to  explain 
to  our  students?    Iritis,  in  eye,  and  acute  otitis 


THE   HOSPITAL  BULLETIN 


media,  in  ear  diseases,  are  very  common  troubles. 
Both  are,  as  a  rule,  readily  diagnosed,  and  both 
offer  good  prognosis.  Yet  the  responsibility  for 
eyesight  in  one,  and  may  be  life  in  the  other,  may 
depend  on  the  diagnostic  ability  and  therapeutic 
resources  of  the  man  who  first  sees  the  case.  Men 
are  blind  and  children  dead  because  a  general 
practitioner  has  not  known  enough  of  what  was 
offered  him  when  a  student  to  make  a  correct  di- 
agnosis. The  red  eye  has  been  called  conjuncti- 
vitis and  treated  with  nitrate  of  silver,  in  spite  of 
the  absence  of  purulency,  while  the  small,  inac- 
tive pupil  has  escaped  notice.  The  ear  pain  has 
been  called  "earache"  without  an  aural  examina- 
tion, a  hops  bag  and  opium  have  been  ordered, 
and  the  doctor  has  gone  home  with  that  false 
sense  of  security  which  is  so  dangerous.  Why? 
If  his  teacher  has  known  his  business,  it  is  not 
because  he  was  not  told  how  to  look  for  iritis  and 
acute  inflammation  of  the  drum,  but  because  he 
had  not  given  the  subjects  sufficient  thought  to 
get  them  drilled  into  his  thinking  apparatus. 
Probably  he  could  tell  the  diagnostic  points  of 
iritis,  if  asked,  or  the  signs  of  ear-drum  inflam- 
mation ;  but  this  was  "crammed"  information, 
not  part  of  his  real  knowledge. 

If  it  is  the  duty  of  the  student,  anticipating 
general  practice,  to  think  about  the  specialties 
taught  during  his  undergraduate  course,  it  is  still 
more  the  duty  of  his  teacher  to  present  him  only 
such  things  as  the  general  man  needs.  He  will 
make  a  grievous  blunder  if  he  tries  to  make  spe- 
cialists of  his  men.  His  selection  of  subjects 
should  be  limited  to  the  diseases  which  are  of 
common  occurrence,  and  stress  should  be  laid  on 
diagnosis.  If  one  knows,  first,  what  to  look  for, 
and  secondly  how  to  recognize  signs  and  symp- 
toms, he  will  generally  find  proper  treatment. 
Troubles  which  would  lead  the  patient  to  go  to 
the  specialist  primarily,  without  consulting  his 
family  physician,  should  receive  little  attention. 

Two  other  classes  of  lesions  in  such  organs  as 
are  usually  handed  over  to  specialists  should  re- 
ceive attention  in  the  undergraduate  course — 
those  which  are  apt  to  cause  remote  or  reflex  dis- 
turbances, and  those  which  are  definitely  symp- 
tomatic of  central  lesions.  The  first  should,  in 
my  judgment,  be  dwelt  upon  only  to  such  an  ex- 
tent as  to  enable  the  student  to  know  causative  re- 
lation and  method  of  diagnosis.  Treatment,  un- 
less very  simple  and  easily  within  the  reach  of  the 
medical    man — i.    e..    the    general    practitioner — 


should  be  given  little  time.  As  to  the  second 
class,  every  neurologist  knows  that  Tabes  Dor- 
salis  would  often  be  diagnosed  early,  and  proper 
treatment  instituted,  if  the  physician  had  known 
the  meaning  of  association  of  gastric  crises  with 
Argyll-Robertson  pupil,  and  had  seen  enough  of 
these  things  to  have  them  in  his  every-day 
thoughts.  One  could  present  many  other  illus- 
trations, but  this  shows  what  is  meant.  With 
the  student  convinced  of  the  necessity  of  think- 
ing about  the  specialty  taught,  the  instructor 
careful  in  selection  of  his  subjects,  a  duty  rests 
on  those  who  fix  the  curriculum. 

It  is  unfair  to  students  to  use  four  years  for 
work  which  can  be  done  in  three.     I  believe  that 
the  object  of  the  establishment  of   a   four-year 
course  was  to  furnish  a  year  in  which  students, 
freed    from   the    responsibility   of   examinations, 
might  have  time  for  guidance  in  clinical  observa- 
tion.    The  ideal  plan,  in  my  judgment,  is  to  get 
rid  of  didactic  lectures  and  examinations  by  the 
end  of  the  third  year,  and  to  devote  the  fourth 
to     clinical     observation.     Genito-urinary  work, 
gynaecology,    rhinology,   neurology,   ophthalmol- 
ogy, otology,  cannot  be  learned  from  text-books 
or  lectures,  at  least  in  such  a  way  as  to  become 
integral  parts  of  a  man's  daily  thinking.    And  to 
my  mind  this     is     the  only  special  information 
which  will  help  the  general  practitioner   in   his 
daily  work.     A  few  hours  spent  in  a  large  clinic 
brings  more  instruction  than  a  whole  year  of  lec- 
tures.    The  personal  contact  of  man  to  man,  the 
exchange  of  thoughts  and  impressions,  are  what 
sink  in.    A  student  is  not  to  be  blamed  if  he  fails 
to  attend  these  opportunities  when  he  knows  that 
in  a  few  weeks  he  must  face  the  ordeal  of  exami- 
nations on  the  didactic  work,  and  that  the  result 
of  these  will  determine  his  graduation.     To  put 
into  a  few  words  my  idea  of  teaching  specialties 
— it  is   the   duty  of  the   student  to  realize  that 
nothing    is    put    into    the    undergraduate    course 
which  is  not  important  to  him;  it  is  the  duty  of 
the  teacher  to  select  only  what  is  important  to  the 
general  practitioner ;  it  is  the  duty  of  the  school 
authorities   to   so  arrange  the  curriculum   as  to 
give    students    enough    time    to    observe    special 
practice  personally,  in  small  sections,     so     that 
what  is  taught  may  be  so  impressed  by  observa- 
tion as  to  become  a  real  factor  in  their  medical 
thought. 


48 


THE   HOSPITAL   BULLETIN 


A  CASE  OF  SPORADIC  CRETINISM. 

r»Y  E.  Sanborn  Smith,  M.  D.. 

Class  of  1900,  Macon,  Mo. 

Karl  B.  is  the  son  of  sturdy  parents,  both  of 
whom  were  born  and  reared  in  the  Swiss  Tyrol. 
I  Ie  had  never  developed  like  the  other  children — 
was,  in  fact,  much  smaller  at  five  and  a  half 
years  than  the  fourteen-months-old  baby.  He 
was  dull,  placid,  taking  no  note  of  his  surround- 
ings, sitting  or  lying  just  where  he  was  left,  and 
never  evinced  any  disposition  to  play  or  converse 
with  the  other  children.  I  saw  this  child  on  the 
4th  day  of  January,  1908.  in  a  purely  accidental 
manner.  The  parents  had  been  told  by  their  at- 
tendant that  the  child  bail  either  rickets  or  was 
an  idiot,  and  they  in  consequence  had  kept  the 
child  in  the  background  for  two  or  three  years, 
being  very  much  chagrined  and  mortified  at  the 
prospect  of  bearing  through  life  the  burden  of 
hopeless  idiocy.  The  child  had  such  classical 
symptoms  of  cretinism  that  1  asked  permission  of 
the  family  to  treat  him  for  awhile,  though  it  re- 
quired some  persuasion,  because  of  the  fact  that 
they  felt  it  was  time  and  money  wasted.  On  the 
5th  day  of  January.  n>o8,  the  child  was  five 
years  and  a  half  old.  twenty-eight  inches  in 
height,  circumference  of  chest  twenty-one,  abdo- 
men twenty-three.  He  was  given  one  and  one- 
half  grains  of  thyroid  extract  twice  daily,  the 
dose  being  gradually  increased  until  he  showed 
signs  of  irritability,  with  accelerated  pulse.  The 
child's  extremities  soon  warmed  up,  the  circula- 
tion became  better,  the  hair  began  to  grow,  the 
child  for  the  first  time  in  its  life  walked  and 
talked,  began  to  take  note  of  surroundings  and 
to  play  with  the  other  children. 

Just  one  year  after  the  beginning  of  the  treat- 
ment— January  5,  1909 — the  child  was  thirty-five 
and  three-quarter  inches  in  height,  chest  twenty- 
three,  abdomen  twenty-three. 

This  disease,  sometimes  known  as  cretinoid 
or  myxoedematous  idiocy,  was  first  described  by 
Fagg  in  1871.  Since  then  a  number  of  cases 
have  been  published,  both  in  England,  on  the 
Continent  and  in  America,  showing  that  the  dis- 
ease is  not  confined  to  any  one  country.  While 
the  disease  is  comparatively  rare,  cretins  are  more 
common  than  was  formerly  supposed.  The  dis- 
ease seems  to  be  in  reality  a  pachydermatous 
cachexia,  and  it  is  now.  I  believe,  well  estab- 
lished that  it  is  caused  by  congenital  absence  of 
the  thyroid  gland  or  to  the  presence  of  something 


which  abolishes  its  functions.  Little  is  known  as 
to  the  causes  of  its  destruction  or  abolishment  of 
function.  As  a  rule  only  one  case  occurs  in  a 
family,  the  other  members  presenting  nothing 
abnormal  in  their  mental  or  physical  develop- 
ment, hence  the  term  sporadic.  It  has  been  more 
frequently  reported  in  the  Tyrol,  in  Switzerland, 
a  coincidence  which  makes  this  child's  case  all  the 
more  interesting,  in  that  both  its  parents  are 
physically  and  mentally  well  up  to  par  and  the 
other  children  possess  even  more  than  the  aver- 
age intelligence. 

Symptoms — The  symptoms  are  practically 
identical  with  those  of  the  myxoedema  which  fol- 
lows the  removal  of  the  thyroid  gland  in  adults. 
The  symptoms  of  cretinism  in  most  cases  in  in- 
fants make  their  appearance  during  the  first  year, 
occasionally,  however,  not  until  the  child  is  three 
or  four  years  of  age.  The  appearance  of  the  cre- 
tin is  very  striking,  and  so  characteristic  that 
when  once  seen  the  disease  can  hardly  fail  to  be 
recognized.  The  child  is  much  dwarfed,  the 
fingers  and  toes  are  short  and  stumpy,  the  cuta- 
neous tissues  seem  to  be  thick  and  boggy,  but  do 
not  pit  on  pressure,  as  in  ordinary  oedema.  The 
facies  is  extremely  characteristic.  The  head 
seems  large  for  the  body,  the  fontanel  is  open 
until  the  eighth  or  tenth  year,  the  forehead  is  low 
and  the  base  of  the  nose  broad,  so  that  the  eyes 
seem  unusually  wide  apart.  The  lips  are  thick, 
the  mouth  half  open  and  the  tongue  protrudes 
slightly,  the  cheeks  are  baggy  and  the  hair  is 
coarse,  short  and  straight,  and  the  skin  has  the 
peculiar  leathery  feel  of  elephant  skin.  The  ab- 
domen is  pendulous,  large,  streaked  with  promi- 
nent veins,  and  reminds  one  of  rickets.  The  skin 
is  dry,  the  voice  husky  and  rough.  There  is  but 
one  word  which  describes  the  peculiar  clumsy 
manner  of  walking — that  word  is  waddle.  The 
child  actually  waddles  like  a  duck.  The  tempera- 
ture is  always  subnormal,  and  one  of  the  things 
the  mother  will  always  call  to  your  attention  is 
the  fact  that  the  child  has  such  cold  hands  and 
feet  and  requires  so  much  more  cover  than  the 
other  children.  Cretins  are  dull,  placid  and  good 
natured,  never  quarrelsome. 

Treatment — There  is  no  tendency  toward  spon 
taneous  improvement.  These  cases  have  until 
the  last  few  years  been  considered  hopeless  and 
condemned  to  a  life  of  idiocy.  Really,  in  the 
treatment  of  cretinism  in  the  adult  marvelous  re- 
sults have  been  got   from  the  administration  of 


THE   HOSPITAL   BULLETIN 


49 


the  dried  and  dessicated  extract  of  the  thyroid 
gland  of  the  sheep.  This  has  led  to  its  use  in  the 
myxoedema  of  infancy.  The  results  are  astound- 
ing. The  child  grows  mentally  and  physically, 
takes  note  of  surroundings  to  which  it  formerly 
paid  no  attention  whatever,  and  can  be  taught  al- 
most as  well  as  a  perfectly  normal  child.  In  all 
cases  the  thyroid  extract  must  be  kept  up  indefi- 
nitely, the  dose  being  gradually  increased,  other- 
wise the  improvement  ceases  at  once. 


ITEMS. 

At  the  commencement  of  the  University  Hos- 
pital School  for  Nurses,  held  May  5th,  the  fol- 
lowing nurses  received  their  diplomas.  The  ad- 
dress to  the  graduates  was  delivered  by  Dr.  A. 
M.  Shipley: 

Miss  Elizabeth  Getzendanner  was  the  president 
of  the  class,  and  Miss  Lucy  B.  Squires  was  the 
secretary. 

Those  who  received  diplomas  were : 

Miss  Catherine  Mabel  Dukes,  Maryland. 

Miss  Anna  May  Green,  North  Carolina. 

Miss  Laura  Schley  Chapline,  West  Virginia. 

Miss  Louise  Dorsey  Pue,  Maryland. 

Miss  Grace  Schoolfield  Tull,  Maryland. 

Miss  Annie  Lou  Wahm,  South  Carolina. 

Miss  Eva  Sidney  Chapline,  West  Virginia. 

Miss  Beulah  Ophelia  Hall,  Georgia. 

Miss  Elizabeth  Getzendanner,  Maryland. 

Miss  Emily  Lavinia  Ely,  Maryland. 

Miss  Lucy  Bright  Squires,  North  Carolina. 

Miss  Gertrude  Hedwig  Tews,  Germany. 

Miss  Helen  Mary  Robey,  Maryland. 

Miss  Blanche  Almond,  Virginia. 

Miss  Lillie  Booker  Carter.  Virginia. 

Miss  Mary  Barton  Saulsbury,  Maryland. 

Miss  Vera  Wright,  Maryland. 


The  alumni  of  the  University  will  be  pained  to 
learn  of  the  recent  illness  of  Prof.  S.  C.  Chew. 
The  Bulletin  is  glad  to  report  that  he  is  now 
convalescing.  No  member  of  the  Faculty  is  more 
esteemed  and  beloved  than  is  Professor  Chew. 


Dr.  Leonard  O.  Sloane,  of  Juneau,  Alaska, 
who  has  been  visiting  Baltimore  for  several 
weeks,  has  left  the  city.  He  came  to  this  city  to 
avail  himself  of  the  opportunities  for  clinical  in- 
struction offered  by  this  University,  and  was 
much  pleased  with  the  work  he  was  able  to  see 


at  the  University  Hospital,  the  Woman's  Hos- 
pital, the  Hebrew  Hospital  and  at  Bay  View.  He 
is  physician  to  St.  Ann's  Hospital,  at  Juneau,  and 
is  a  progressive  and  able  member  of  our  profes- 
sion. 


In  the  recent  examinations  held  for  commis- 
sions in  the  medical  corps  of  the  United  States 
Army,  Dr.  J.  S.  Fox,  one  of  the  surgeons  at  the 
St.  Francis  Xavier  Hospital,  was  a  successful 
contestant,  and  the  War  Department  has  notified 
him  that  he  will  be  commissioned  a  first  lieuten- 
ant and  will  be  ordered  to  proceed  to  a  post  in  the 
West.  One  hundred  doctors  took  the  examina- 
tion for  the  appointments,  but  only  thirteen  were 
successful.  Dr.  Fox,  who  will  be  one  of  the 
youngest  surgeons  in  the  Army,  was  high  up  in 
the  list  of  the  fortunate  ones. 

Dr.  Fox  is  a  son  of  the  late  Dr.  T.  S.  Fox,  of 
Batesburg,  who  was  a  distinguished  surgeon  in 
the  Confederate  Army.  He  is  a  nephew  of  Mr. 
J.  T.  Fox,  of  that  town.  Dr.  Fox  is  twenty-nine 
years  of  age,  and  was  born  in  Batesburg,  S.  C. 
After  completing  the  high  school  at  that  place 
he  entered  Richmond  College,  Richmond,  \  a  . 
and  was  there  for  three  years,  when  he  entered 
the  Medical  College  at  Baltimore.  Fourteen 
months  ago  he  came  to  Charleston  to  accept  an 
appointment  as  one  of  the  house  surgeons  of  the 
St.  Francis  Xavier  Infirmary,  and  during  his  stay 
in  this  city  has  made  a  fine  record  for  himself, 
and  now  has  many  friends  here. 

As  soon  as  his  commission  arrives  he  will  leave 
here  for  Fort  Sam  Houston,  Texas,  the  station 
designated  in  the  orders  of  the  War  Department. 
There  are  at  present  several  troops  of  the  Third 
Cavalry  and  a  battalion  of  light  artillery  from  the 
Third  Field  Artillery  Regiment  stationed  at  this 
important  post,  which  is  considered  to  be  one  of 
the  most  agreeable  army  posts  in  the  South.  On 
October  I,  Dr.  Fox  will  be  ordered  to  report  to 
Washington,  where  he  will  be  detailed  to  attend 
the  Army  Medical  College  for  a  period  of  eight 
months. 


The  Council  on  Pharmacy  and  Chemistry  and 
the  Board  of  Trustees  of  the  American  Medical 
Association  have  adopted  a  vote  of  thanks  to 
Daniel  Base,  Ph.  D.,  professor  of  analytical 
chemistry.  Department  of  Medicine,  University 
of  Maryland,  for  his  co-operation  and  assistance 
in  investigating  products  and  for  special  research 
work  done  at  the  request  of  the  Council. 


50 


THE  HOSPITAL  BULLETIN 


It  has  been  definitely  decided  that  the  new  op- 
crating  room  which  is  to  be  built  at  St.  Joseph's 
Hospital  is  to  be  dedicated  to  the  memory  of  Dr. 
Isaac  Ridgeway  Trimble,  who  died  of  septicemia 
after  performing  an  operation  upon  an  infected 
kidney  at  the  hospital,  as  a  result  of  which  the 
patient  lived.  A  tablet  bearing  Dr.  Trimble's 
name  and  the  incidents  surrounding  his  martyr- 
lik-e  death  will  be  placed  in  the  operating  room. 


Dr.  John  R.  Winslow  read  a  paper  on  "A  Case 
of  Tuberculosis  of  the  Fauces  and  Lingual  Ton- 
sils, Caused  by  Tuberculin  Injections,"  before  the 
Section  on  Laryngology  and  Rhinology,  Friday, 
March  26,  1909.  At  the  same  meeting  Dr.  J.  N. 
Reik  read  a  paper  on  "The  Present  Status  of  the 
Surgical  Treatment  of  Purulent  Disease  of  the 
Nasal  and  of  the  Aural  Cellular  Spaces :  a  Com- 
parison." 


Dr.  and  Mrs.  A.  Duvall  Atkinson,  who  have 
been  spending  a  few  days  in  Washington,  have 
returned  to  their  home,  924  North  Charles 
street. 


Under  the  title  of  leading  men  of  Maryland, 
"The  Star"  has  this  to  say  concerning  Dr.  Louis 
McLane   Tiffany: 

Dr.  Louis  McLane  Tiffany  is  not  only  one 
of  the  best-known  men  in  Maryland,  but  en- 
joys a  reputation  that  is  international  as  an  op- 
crating  surgeon.  He  has  performed  success- 
fully many  unusual  and  difficult  operations, 
and  has  contributed  much  to  his  profession  by 
original  research.  He  was  born  in  Baltimore, 
October  10,  1844,  and  is  related  to  the  well- 
known  McLane  family  of  Maryland  and  Dela- 
ware. He  received  his  bachelor  of  arts  degree 
from  Cambridge  University,  England,  in  1866, 
and  upon  his  return  to  Baltimore  entered  the 
University  of  Maryland  as  a  medical  student, 
his  degree  as  doctor  of  medicine  being  con- 
ferred upon  him  in  1868.  He  soon  attained 
prominence  in  his  chosen  work.  For  many 
years  he  has  been  professor  of  the  principles 
and  practice  of  surgery  at  the  University  of 
Maryland.  He  has  been  operating  surgeon  of 
many  of  the  Baltimore  hospitals,  has  per- 
formed operations  on  prominent  persons  all 
over  the  countrv,  and  is  the  author  of  a  num- 


ber of  treatises  on  particular  phases  of  surgery. 
Dr.  Tiffany  helped  to  found  the  Maryland 
Clinical  Society,  is  a  member  of  the  Medical 
and  Chirurgical  Faculty  of  Maryland  and  an 
active  or  honorary  member  of  many  other  so- 
cieties. 


Recently  there  was  unveiled  at  St.  Tim- 
othy's Church,  at  Catonsville,  Md.,  a  beautiful 
memorial  window  designed  and  executed  in 
Favrile  glass  to  the  memory  of  Dr.  Charles 
G.  W.  Macgill,  who  was  president  of  the  First 
National  Bank  of  Catonsville  and  a  physician 
widely  known  in  that  part  of  Baltimore  coun- 
ty. This  memorial,  the  subject  of  which  is  St. 
Luke,  is  in  three  panels,  the  figure  of  the  evan- 
gelist being  in  the  center  opening,  while  a 
splendid  landscape  is  carried  out  in  the  two 
side  panels.  On  a  scroll  carried  by  St.  Luke  is 
the  text:  "For  to  one  is  given  by  the  Spirit  the 
gifts  of  healing."  1  Cor.,  xii :  8-9.  At  the  base 
of  the  window  is  the  dedicatory  inscription : 
"In  Loving  Memory  of  Charles  G.  W.  Macgill. 
Born  May  10th,  1833.     Died  April  28th,  1907." 


At  the  coming  meeting  of  the  American 
Medical  Association  Dr.  Henry  D.  Fry,  of 
Washington,  will  read  a  paper  on  "An  Ovarian 
Abscess  Containing  a  Lunbricoid  Worm  With- 
in the  Cavity;"  H.  D.  Hynson,  Phar.  D.,  "The 
National  Formulary :  Its  Genesis,  Character 
and  Exigent  Utility." 


Dr.  W.  L.  Hart,  class  of  1906,  first  lieuten- 
ant, United  States  Army,  has  been  ordered  to 
accompany  Company  G,  Engineers,  to  San 
Francisco,  Cal.,  and  then  to  return  to  Wash- 
ington Barracks,  D.  C. 


The  following  physicians  have  consented  to 
act  as  admitting  physicians,  Maryland  State 
Sanatorium :  Dr.  Gordon  Wilson,  Baltimore ; 
Dr.  Charles  H.  Conley,  Adamstown.  Dr.  Guy 
Steele,  Cambridge ;  Dr.  Paul  Jones,  Snow  Hill ; 
Dr.  Henry  Fitzhugh,  Westminster.  Drs.  Guy 
Steele  and  C.  II.  Conley  are  members  of  the 
Board  of  Managers. 


THE   HOSPITAL   BULLETIN 


51 


Dr.  A.  M.  Shipley,  class  of  1902,  has  been 
elected  consulting  surgeon  to  the  Sydenham 
Infectious  Hospital,  and  Dr.  H.  O.  Reik,  of  506 
Cathedral  street,  consulting  otologists. 


Dr.  H.  E.  Palmer,  of  Tallahassee,  has  been 
elected  president  of  the  Florida  State  Medical 
Association  for  the  ensuing  year. 


The  marriage  of  Miss  Elizabeth  P.  Elliott, 
daughter  of  Mrs.  Warren  G.  Elliott,  to  Dr. 
Gordon  Wilson,  associate  professor  of  medi- 
cine in  the  University  of  Maryland,  will  take 
place  on  Saturday,  June  5,  1909.  The  cere- 
mony will  be  performed  at  6  o'clock  at  Old  St. 
Paul's  Protestant  Episcopal  Church,  Charles 
and  Saratoga  streets,  by  the  rector,  Rev.  Ar- 
thur B.  Kinsolving.  Owing  to  mourning  in 
the  bride's  family,  the  marriage  will  be  a  quiet 
affair. 


Another  wedding  of  interest  to  take  place  in 
June  is  that  of  Miss  Lila  Holmes  Trenholm, 
daughter  of  Mr.  Glover  Holmes  Trenholm,  a 
graduate  of  the  Training  School  for  Nurses  of 
the  University  Hospital,  and  granddaughter  of 
the  late  Prof.  Julian  Chisholm,  to  Dr.  Walton 
A.  Hopkins,  class  of  1903,  of  Annapolis,  Md. 


At  the  annual  meeting  of  the  Cecil  County 
Medical  Society,  held  in  Elkton,  Md..  April  29, 
1909,  Dr.  C.  P.  Carrico,  of  Cherry  Hill,  was 
elected  president  for  the  ensuing  year. 


Dr.  George  H.  Steuart, 
cated  at  Ottoman,  Ya. 


)f  1898,  is 


Prof.  Samuel  C.  Chew,  the  nestor  of  the 
Medical  Faculty  of  the  University  of  Mary- 
land, is  confined  to  the  University  Hospital 
with  a  bad  attack  of  grip.  Dr.  Chew  is  one  of 
the  oldest  and  most  beloved  of  the  medical 
fraternity  of  Baltimore.  He  has  been  con- 
nected with  the  University  of  Maryland  for 
more  than  fifty  years,  graduating  with  the 
class  of  1858.  All  of  us  wish  Dr.  Chew  a  rapid 
restoration  to  his  former  good  health. 


Forty  professional  men  were  present  May  1, 
1909,  at  the  Colonial  Hotel,  where  the  fourth 
annual  reunion  and  banquet  of  the  Pennsyl- 
vania Branch  of  the  General  Alumni  Associa- 
tion of  the  University  of  Maryland  was  held. 
Dr.  Eugene  F.  Cordell  was  one  of  the  guests ; 
others  were  Dr.  Charles  P.  Noble,  president 
of  the  Pennsylvania  Branch,  and  Dr.  J.  C. 
Beale,  secretary  and  treasurer,  both  of  Phila- 
delphia. 

The  banquet  was  held  in  the  new  assembly 
room,  which  was  tastefully  decorated  with 
plants,  flowers  and  the  colors  of  the  Univer- 
sity. The  banquet  committee  consisted  of  Drs. 
Z.  C.  Myers  and  S.  K.  Pfaltzgraff,  of  York ;  J. 
S.  Classen  and  J.  C.  Beale,  of  Philadelphia. 


It  is  reported  that  Dr.  John  Cox  Keaton, 
class  of  1907,  of  Georgia,  has  been  shot  in  the 
abdomen  by  an  irate  husband. 


At  the  annual  meeting  of  the  Cecil  County 
Medical  Society,  held  at  Elkton,  Dr.  St.  Clair 
Spruill  spoke  on  '"Surgical  Conditions  of  the 
Right  Side  of  the  Abdomen." 


The  New  York  Medical  Journal  says  con- 
cerning the  April  13th  meeting  of  the  Philadel- 
phia Pediatric  Society  :  "The  paper  of  the  even- 
ing was  read  by  Dr.  Compton  Riely,  of  Balti- 
more, on  'The  Early  Diagnosis  and  Treatment 
of  Pott's  Disease.'  " 


The  following  of  our  alumni  are  upon  the 
staff  of  the  Hospital  for  the  Women  of  Mary- 
land, John  street  and  Lafayette  avenue,  Balti- 
more :  Dr.  Charles  H.  Riley,  Dr.  J.  Mason 
Hundley,  Dr.  Archibald  C.  Harrison,  Dr. 
Robert  T.  Wilson,  Dr.  Samuel  T.  Earle  and 
Dr.  George  W.  Dobbin.  Dr.  G.  W.  Billups, 
class  of  1906,  is  resident  physicir.n. 


Mr.  and  Mrs.  William  T.  Schultze,  of  822 
Newington  avenue.  Baltimore,  have  an- 
announced  the  engagement  of  their  daughter, 
Dr.  Anna  D.  Schultze,  a  graduate  of  the 
Woman's  Medical  College  and  resident  physi- 
cian of  the  Good  Samaritan   Hospital,  to  Dr. 


52 


THE   HOSPITAL  BULLETIN 


John  R.  Abercrombie,  dean  of  the  Woman's  Dr.  Thomas  A.  R.  Keech,  class  of  1856,  and 
.Medical  College,  a  graduate  of  the  University  Mrs.  Keech.  of  Washington,  D.  C,  celebrated 
of  Maryland  of  the  class  of  1895,  and  at  pres-  at  their  home,  416  B  street,  northeast,  on  April 
ent  instructor  in  diseases  of  the  skin,  Univer-  13,  1909,  the  fiftieth  anniversary  of  their  mar- 
shy of  Maryland.  No  date  has  been  fixed  for  riage.  The  house  was  beautifully  decorated 
the  wedding.  with  cut  and  potted  plants.     A  collation  was 

served.      The    family   are   of   English   descent, 

having     emigrated  and  settled     in     Southern 

At   the  coming  meeting  of     the     American      Maryland  about   1750.     Dr.  Keech  is  a  son  of 

Medical  Association  Dr.  I.  S.  Stone,  of  Wash-      the  late  Rev.  John  Reeder  and  Susan  P.  Keech. 

ington,  will  read  a  paper  on  "Some  Minor  Gyn-  

ecologic     Matters     Which     Are     Often     Over- 
looked "  Dr.  John    Herbert   Bates,   class  of   1907,   of 

Forest  Park,  Baltimore,  a  former  resident  phy- 
sician of  Pay  View  Hospital,  and  until  recently 
a  resident  physician  at  the  Church  Home  and 
Infirmary,  has  located  at  4002  Main  avenue, 
Forest    I 'ark. 


Dr.  Charles  H.  Medders,  of  Baltimore,  who 
sued  the  Western  Maryland  Railroad  for 
$5,000  for  services  rendered  in  a  collision  four 
years  ago,  was  rendered  a  verdict  for  $150. 


At  the  animal  meeting  of  the  Montgomery 
County  Medical  .Association,  held  in  Rockville, 
April  20,  1909.  the  following  of  our  alumni 
were  elected  to  office  for  the  ensuing  year: 
Vice  president.  Dr.  Wm.  L.  Lewis,  of  Ken- 
sington ;  secretary-treasurer,  Dr.  John  L. 
Lewis,  of  Bethesda. 


Society     has 


jllowing  offices  for 


The   Baltimore   City   Medica 
elected  our  alumni  to  the 
the  ensuing  year:   President,  Dr.  Jacob  Hart- 
man  ;  board  of  censors,  Dr.  Randolph  Winslow 


The  third  animal  banquet  of  the  General 
Alumni  Association  of  the  University  of  Mary- 
land was  held  Thursday,  April  22,  1909,  at  the 
Eutaw  I  louse.  Baltimore.  About  90  were 
present.  The  affair  was  a  thoroughly  enjoy- 
able occasion,  but  more  enthusiasm  would  have 
been  evident  if  more  of  the  members  of  the 
various  faculties  had  been  present.  The  Phar- 
maceutical Department,  with  less  professors 
than  the  other  departments,  had  most  mem- 
bers present.  The  speeches  were  witty  and  in- 
structive, and  teemed  with  expressions  of  loy- 
alty to  the  University.  As  oft  iterated  and  re- 
iterated, this  body  is  the  only  real  live  alumni 
body  at  the  University  of  Maryland.  It  has 
been,  doing  since  its  inception,  and  is  still 
doing,  and  if  the  University  ever  be  rejuve- 
nated much  of  the  credit  will  be  due  to  the 
constant  agitation  of  this  body  for  a  larger  and 
better  university.  Most  alumni  banquets  con- 
sist of  a  feed,  good,  better  or  worse,  as  it  might 
happen  to  be,  and  a  slew  of  speech  artists  of 

more  or  less  renown,  who  bubble  over  with  big 

words  of  encouragement  and  prediction,  but 
Dr.   A.    E.   Ewens,   of   Atlantic    City,   was   a      rest  on  their  oars  here.     Indeed,  the  societies 

member  of  the  Committee  on  Section  Meetings      exist  for  a  banquet  once  a  year  and  a  cyclone 

at  the  recent  meeting  of  the  American  Medical 

Association.      Dr.   Daniel  Jenifer  also  had  the 

honor  and  pleasure  of  serving  upon  this  com- 
mittee.    Dr.  Jenifer  was  also  a  member  of  the 

Committee  on  Postoffice  and  Telephone.     Dr. 

A.  E.  Ewens  also  served  on  the  Committee  on 

Badges. 


Dr.  G.  Lane  Tanevhill,  of  Baltimore,  is  a 
member  of  the  House  of  Delegates  of  the 
American  Medical  Association  from  Maryland 
at  the  present  meeting  of  the  American  Medi- 
cal Association,  at  Atlantic  City. 


of  hot  air.  \\  hat  do  words  accomplish?  Noth- 
ing. It  is  action  that  the  University  of  Mary- 
land needs,  and  more  than  anything  else  men 
of  action — strong  men,  broad-minded  men, 
men  who  can  subordinate  their  success  to  the 
success  of  the  institution,  men  in  every  sense 
of  the   word.     I   am   glad  to  say  the   General 


THE   HOSPITAL   BULLETIN 


53 


Alumni  Association  has  an  abundance  of  men 
of  such  character  among'  its  membership  who 
are  doing  something  for  the  good  of  the  Old 
University,  and  who  have  an  object  in  view. 
What  is  this  object?  The  creating  of  ways 
and  means  for  the  betterment  of  the  Univer- 
sity. 

At  the  business  meeting  immediately  preced- 
ing the  banquet  the  following  recommendation 
of  the  special  committee  appointed  for  the  pur- 
pose of  formulating  a  plan  for  the  participa- 
tion of  the  alumni  in  the  management  of  the 
University  was   adopted  unanimously. 

The  plan  provides  that  the  Board  of  Regents 
of  the  University  shall  be  enlarged  by  the  addi- 
tion of  five  members,  one  each  from  the  five  de- 
partments, who  shall  have  had  their  degrees 
for  10  years  or  more.  It  provides  for  the  elec- 
tion of  a  committee  on  nominations,  to  consist 
of  the  president  of  the  association  and  one  rep- 
resentative from  each  of  the  five  departments. 
This  committee  shall  select  three  representa- 
tives from  each  of  the  five  departments  as  nom- 
inees for  the  alumni  in  good  standing  in  the  as- 
sociation to  vote  upon.  Votes  may  be  cast  in 
person  or  by  mail.  After  the  election  of  the 
five  members  of  the  council  they  shall  deter- 
mine by  lot  who  are  to  serve  for  one,  two, 
three,  four  or  five  years,  respectively. 

Any  vacancy  is  to  be  filled  by  the  remaining 
members  of  the  Alumni  Council  from  the  depart- 
ment from  which  the  member  was  originally 
chosen.  The  secretary  of  the  General  Alumni 
Association  shall  act  as  the  secretary  of  the 
alumni  regents,  who  shall  select  their  own  chair- 
man for  one-year  terms. 

The  committee  consisted  of  the  following 
well-known  alumni  of  the  five  departments  oi 
the  University: 

Medical — Dr.  1!.  .Merrill  Hopkinson  and  Dr. 
E.  F.  Cordell. 

Pharmacy — Dr.  John  F.  Hancock  and  Dr.  J. 
Emory  Bond. 

Dental — Dr.  L.  Ii.  Farinholt  and  Dr.  Joseph 
C.  Heuisler. 

Law — Messrs.  B.  Howard  Haitian  and  [as. 
YV.   Bowers,  Jr. 

Academic  (St.  John's  College) — Dr.  J.  Fred- 
erick Adams  and  Dr.  A.  L.  "Wilkinson. 

Xo  further  action,  however,  can  be  taken  in 
the  matter  until  approved  or  vetoed  by  the 
Board  of  Regents. 


The  president.  John  B.  Thomas,  Phar.  D., 
introduced  the  toastmaster,  Henry  P.  Hynson, 
I 'bar.  I).,  who  was  in  a  particularly  bright  and 
witty  mood.  The  speakers  were:  Hon.  J.  Barry 
Mahool,  the  .Mayor  of  Baltimore;  John  C. 
Hemmeter,  M.  D. ;  Addison  Mullikin,  Esq.,  LL. 
B.;  Charles  Caspari.  Phar.  I). :  Joshua  W.  Her- 
ing,  M.  D.,  Comptroller  of  the  State  of  Mary- 
land and  a  graduate  of  the  class  of  1855,  of 
Westminster,  Md. 

Those  who  were  not  present  do  not  know 
what  they  missed.  It  was  a  live  banquet, 
something  doing  every  minute,  and  the  com- 
mittee in  charge  of  the  arrangements  are  to  be 
congratulated  upon  the  thoroughness  with 
which  they  accomplished  their  task. 

Committee — T.  O.  Heatwole,  chairman  ;  Or- 
egon Milton  Dennis,  LL.  B. ;  Eugene  Hodson, 
Phar.  G.;  Arthur  M.  Shipley,  M.  D. 

Among  those  present  were:  William  Tarun, 
Dr.  J.  W.  Bird,  J.  Huff,  Dr.  Compton  Reilly, 
J.  Cromwell,  Dr.  Randolph  Winslow,  Dr.  R.  B. 
Hayes,  C.  V.  Mace,  L.  M.  Allen,  Dr.  R.  H.  P. 
Bay,  Dr.  I.  J.  Spear,  H.  II.  Richards,  Dr.  J.  F. 
Hawkins.  Dr.  W.  V.  S.  Levy.  T.  Marshall 
West.  S.  W.  Moore.  1.  H.  Davis,  Dr.  C.  V. 
Matthews,  F.  J.  Valentine,  E.  B.  Howell,  A.  P. 
Scarborough,  (i.  1'".  Dean.  <i.  A.  Hunting,  John 
C.  Uhler,  C.  S.  Grindall,  Dr.  J.  C.  Hemmeter, 
Dr.  A.  M.  Shipley,  John  Henry  Keene.  Dr. 
Robert  L.  Mitchell.  Judge  11.  Stock-bridge.  X. 
II.  D.  Cox.  Dr.  J.  II.  Holland.  Dr.  Charles 
Caspari,  Jr..  II.  1'.  Hynson.  F.  V.  Rhodes.  J.  E. 
Hengst.  (  ).  C.  Harris.  A.  S.  Binswanger,  Dr. 
St.  Clair  Spruill,  Dr.  I-"..  F.  Cordell,  Dr.  Nathan 
Winslow,  Dr.  J.  M.  Hundley.  Daniel  Base.  Dr. 
Charles  E.  Sadtler,  Addison  Mullikin,  II.  VV. 
Jones,  Dr.  G.  Lane  Taneyhill.  Dr.  L.  B.  Ilen- 
kel,  Jr.,  Dr.  I.  C.  Dickson.  I".  J.  S.  Gorgas,  Dr. 
T.  O.  Heatwole,  J.  W.  flowers,  Jr.,  Dr.  J.  W. 
Hering,  Alfred  E.  Kemp,  Oscar  1'..  Thomas. 
J.  B.  Thomas.  Eugene  W.  Hudson.  John  F. 
Hancock.  W.  M.  Fouch,  D.  K.  Millard,  Emory- 
Bond.  C.  A.  Yolkmar.  Frank  Black.  II.  P.  Hyn- 
son. J.  W.  Westcott,  Dr.  C.  H.Medders,  I'..  El- 
liott. Dr.  Eugene  Cordell.  Leroy  Oldham.  A. 
R.  Dohme,  II.  A.  Lillich,  Oregon  Milton  Den- 
nis. L.  W.  Farinholt,  T.  E.  Latimer.  Ambrose 
Murphy,  Dr.  Henry  Kennard,  Dr.  Herbert 
Zepp. 


54 


THE   HOSPITAL  BULLETIN 


The  "Clinic,"  the  year  book  of  the  College  of 
Physicians  and  Surgeons,  Baltimore,  which  has 
just  been  issued,  is  dedicated  to  the  memory 
of  the  late  Dr.  Isaac  Ridgeway  Trimble,  who 
gave  his  life  that  another's  might  be  saved.  Dr. 
Trimble  was  a  graduate  of  the  University  of 
Maryland,  class  of  1884,  and  at  the  time  of  his 
death  was  Professor  of  Anatomy  in  the  College 
of  Physicians  and  Surgeons. 


Dr.  A.  J.  Edwards,  class  of  1898,  of  Bristol, 
1  enn.j  is  spending  a  few  days  around  the 
Hospital  renewing  old  acquaintances. 


Dr.  Luther  Bare,  of  Westminster,  Md.,  was 
a  recent  visitor  to  the  University  Hospital. 


The  banquet  of  the  Medical  Alumni  Asso- 
ciation will  be  held  on  the  evening  of  May 
31,  1909. 


Dr.  and  Mrs.  B.  Merrill  Hopkinson,  who 
have  been  spending  the  week  at  the  Hotel 
Chamberlin,  Old  Point  Comfort,  Va.,  have  re- 
turned to  the  city. 


The  University  of  Maryland  baseball  team 
defeated  the  Midshipmen  on  the  Naval  Acad- 
emy grounds  recently  by  the  score  of  2  to  o. 
Anderson,  the  box  artist,  struck  out  twenty  of 
the  middies.  The  team  this  year  has  been 
more  than  successful,  and  compares  favorably 
with  the  teams  of  the  larger  colleges.  It  is  un- 
doubtedly the  premier  team  of  Baltimore  this 
year,  and  in  any  other  institution  would  arouse 
untold  enthusiasm  by  its  notable  victories. 


Dr.  Fitz  Randolph  Winslow,  class  of  1906,  of 
Hinton,  Va.,  paid  a  flying  visit  to  the  Hospital 
recently. 


Amongst  those  who  responded  to  toasts  at 
the  recent  banquet  of  the  local  branch  of  the 
Haverford  College  Alumni  Association  was 
Dr.  Henry  M.  Thomas. 


Dr.  Fitz  Randolph  Winslow  writes  from 
Hinton,  Va.,  in  the  Valley  of  the  Shenandoah, 
the  garden  spot  of  Virginia,  and  for  pic- 
turesque scenery  unexcelled  in  no  part  of  the 
world,  that  he  is  doing  nicely.  He  has  seen 
three  goitres  and  heard  of  a  wonderful  cure  for 
the  same  from  an  old  mountain  woman.  She 
took  her  own  medicine,  and  claims  to  have 
been  benefited,  so  he  gives  the  recipe :  Put 
your  hands  behind  your  back,  bend  over  and 
take  a  horse's  head  between  your  teeth.  Un- 
fortunately, he  forgot  to  find  out  the  statuo  quo 
of  the  horse,  so  you  might  try  the  dead  or  the 
quick,  as  suits  your  convenience.  Her  goitre 
is  still  very  apparent,  but,  sad  to  relate,  she  has 
no  teeth  left  with  which  to  finish  the  job.  This 
is  only  one  specimen  of  the  gross  ignorance 
and  superstition  of  the  hill  people.  They  treat 
or  mistreat  themselves  often  when  ill  princi- 
pally by  making  teas  of  various  herbs,  such  as 
boneset,  etc.  Skunk  oil  is  a  panacea  both  in- 
ternally and  externally.  He  expects  no  re- 
spectable disease  can  live  in  the  same  neigh- 
borhood with  such  an  odoriferous  medicament. 


Dr.  John  Chaplain  Travers,  class  of  1895,  of 
Cambridge,  who  recently  left  for  the  Philip- 
pines, where  he  will  enter  the  govern- 
ment service,  gave  a  farewell  entertainment  be- 
fore leaving  at  the  residence  of  Capt.  James  C. 
Leonard. 


Dr.  J.  Clement  Clark,  superintendent  of  the 
Springfield  State  Hospital,  presided  at  the 
third  meeting  of  the  Maryland  Psychiatric  So- 
ciety, which  was  held  at  the  Sykesville  institu- 
tion. Among  those  present  were:  Drs.  J.  C. 
Clarke,  Marshall  L.  Price,  Wm.  F.  Wohwartz, 
R.  R.  Norris,  F.  J.  Flannery. 


Dr.  J.  W.   Hering,  class  of   1855,  of  West-  It   gives   us   pleasure   to  announce   that   Dr. 

minster  and  State  Comptroller,  who  has  been  Charles  H.  Mayo,  of  Rochester,  Minn.,  one  of 

visiting  his  son  and  daughter-in-law,  Dr.  and  the  renowned  Mayo  brothers,  has  accepted  the 

Mrs.  Joseph  T.  Hering,  at  the  St.  Paul,  Balti-  invitation  of  the  Faculty  of  Physic  to  deliver  a 

more,  has  returned  to  his  home,  in  Westmin-  course  of  lectures  on  diseases  on  the  thyroid 

ster.  gland  in  the  fall. 


THE   HOSPITAL  BULLETIN 


oo 


Dr.  Lee  Cohen,  of  Baltimore,  will  read  a 
paper  at  the  coming  meeting  of  the  American 
Medical  Association  on  "Post  Operative  Ton- 
sillar Bleeding :  Its  Surgical  Control,  with 
Mention  of  Cases;"  Dr.  R.  L.  Randolph,  of 
Baltimore,  on  "Rodent  Ulcer  of  the  Cornea ;" 
Dr.  Samuel  Theobald,  of  Baltimore,  on  "Re- 
flex Aural  Neurosis  Caused  by  Eye  Strain, 
with  Report  of  Cases." 


chair.  This  is  the  last  meeting  of  the  society 
until  the  fall.  Dr.  Woods'  paper  appears  else- 
where in  this  number. 


One  of  the  marked  developments  of  the 
Democratic  State  Central  Committee  was  a 
practically  unanimous  sentiment  in  favor  of 
the  renomination  of  Dr.  Joshua  W.  Hering, 
class  of  1855,  for  State  Comptroller.  State  and 
county  leaders  were  outspoken  in  their  opinion 
that  Dr.  Hering's  popularity  throughout  the 
state,  as  well  as  his  excellent  record  as  Comp- 
troller, make  his  nomination  virtually  a  matter 
of  course. 


The  condition  of  Dr.  R.  A.  Warren,  of  Hot 
Springs,  Va.,  class  of  1907.  who  was  operated 
on  recently  at  the  University  Hospital  for  ap- 
pendicitis, is  reported  to  be  favorable. 


Dr.  Randolph  Winslow  desires  to  acknowl 
edge  cards  from  Drs.  M.  Zaki  and  M.  Teufik, 
166  Mohamed  Aly  street,  Cairo,  Egypt.  These 
are  two  of  our  popular  Egyptian  students,  and 
are  located  as  noted  above,  where  they  have 
met  with  unexpected  success.  Drs.  Heilig, 
Moose,  Kerr  and  Pearlstine,  four  of  our  recent 
Southern  alumni,  paid  their  respects  to  the 
University  recently.  The  three  former  are  lo- 
cated in  North  Carolina,  the  latter  in  South 
Carolina. 


The  last  regular  meeting  of  the  University 
of  Maryland  Medical  Association  was  held  in 
the  amphitheatre  of  the  University  Hospital, 
Wednesday,  April  21,  1909,  and  the  program 
was  as  follows:  1.  "Preliminary  Training 
Necessary  for  Those  Contemplating  the  Study 
of  Medicine."  Dr.  Randolph  Winslow ;  2,  "The 
Teaching  of  Therapeutics,"  Dr.  C.  W.  Mitch- 
ell; "The  Teaching  of  the  Specialties,"  Dr.  Hi- 
ram Woods. 

The  meeting  was  well  attended  and  the 
papers  were  both  instructive  and  interesting. 
Dr.  A.  M.  Shipley,  the  president,  occupied  the 


Dr.  Richard  H.  Johnston,  of  Baltimore,  will 
read  a  paper  on  "Benign  Tumors  of  the  Turbi- 
nate Bodies  Clinically  and  Pathologically  Con- 
sidered," at  the  coming  meeting  of  the  Amer- 
ican Medical  Association. 


The  Council  on  Medical  Education  of  the 
American  Medical  Association  in  its  annual  re- 
port has  this  to  say  concerning  college  mer- 
gers : 

Another  encouraging  fact  to  be  noted  is  the 
mergers  being  made  among  medical  schools 
whereby  stronger  schools  are  resulting.  Not- 
ably in  Indiana,  all  of  the  regular  schools  in 
the  state  merged  into  the  medical  department 
of  Indiana  University,  while  in  Kentucky  all 
of  the  medical  schools  merged  into  the  Uni- 
versity of  Louisville.  In  Cincinnati  the  two 
regular  schools  merged  into  the  University  of 
Cincinnati  ;  in  Minnesota  Hamline  merged  into 
the  medical  department  of  the  University  of 
Minnesota. 

There  are  numerous  other  cities  where  mer- 
gers might  be  brought  about  if  those  interested 
in  general  education  and  those  in  medical  edu- 
cation in  each  city  would  work  together  to  se- 
cure them.  For  example,  if  all  the  medical  col- 
leges of  any  large  city,  such  as  Chicago,  Phila- 
delphia, St.  Louis  or  others,  could  be  merged 
into  one  great  university  medical  school,  such 
as  are  to  be  found  in  Berlin,  Paris  or  Vienna. 
it  would  be  of  the  greatest  possible  advantage 
to  medical  education  in  America. 

In  the  evolution  of  general  and  medical  ed- 
ucation in  this  country  it  is  becoming  more  and 
more  evident  that  a  well-rounded  university 
needs  a  strong  medical  department,  and  it  is 
now  equally  clear  that  a  medical  school  cannot 
reach  the  highest  stage  of  its  development  ex- 
cept as  the  medical  department  of  a  strong  uni- 
versity. It  is  evident  that  within  a  few  years 
the  medical  schools  of  this  country  will,  with 
few  exceptions,  be  the  medical  departments  of 
universities.  Fortunately  for  the  medical 
school,  the  university  needs  the  medical  school 
quite  as  much  as  the  medical  school  needs  the 
university,  so  that  almost     any     independent 


56 


THE    HOSPITAL   BULLETIN 


medical  school  of  real  merit  can  secure  desir- 
able union  with  a  university.  And  this  change 
will  solve  most  of  our  present  problems  in 
medical  education. 

Since  our  last  conference  there  have  been 
five  important  mergers  of  medical  colleges  by 
which  nine  medical  schools  are  replaced  by 
four  stronger  ones.  These  mergers  were  as 
follows  : 

1.  At  Louisville,  Ky.,  the  Louisville  and 
Hospital  Medical  College,  the  Kentucky 
School  of  Medicine  and  the  University  of 
Louisville  Medical  Department  united,  retain- 
ing the  name  of  the  University  of  Louisville 
Medical  Department.  This  leaves  but  one  reg- 
ular medical  college  in  Louisville,  where  there 
were  live  colleges  two  years  ago.  As  a  direct 
result  of  this  merger,  the  school  has  received 
$25,000  from  the  city  of  Louisville,  and  steps 
have  been  taken  to  build  a  new  city  hospital. 
which  is  to  be  largely  under  the  control  of  the 
medical  sch<  ml. 

2.  At  Cincinnati  the  merger  between  the 
-Medical  College  of  <  'bin  and  the  Miami  Med- 
ical College  has  been  Completed.  the  new 
school  to  be  the  Medical  Department  of  the 
University  of  Cincinnati.  The  building  of  an 
enormous  new  city  hospital  has  already  been 
started  near  the  university  campus,  and  a  new- 
medical  college  building  will  be  erected  adjoin- 
ing this  hospital.  The  outlook  for  this  new 
>ehool  is  very  encouraging. 

3.  The  Keokuk  Medical  College,  College  of 
Physicians  and  Surgeons,  located  at  Keokuk. 
Iowa,  has  turned  all  its  property  and  good  will 
over  to  the  Drake  University,  College  of  Med- 
icine, at  Des  Moines,  Iowa. 

Amalgamation  of  the  Cooper  Medical  Col- 
lege with  Leland  Stanford  University  is  an- 
nounced. Henceforth  the  San  Francisco  insti- 
tution will  be  designated  the  School  of  Medi- 
cine of  Stanford  University.  The  affiliation 
was  given  approval  sometime  ago.  ami  it  only 
remained  for  the  board  of  trustees  of  the  Uni- 
versity to  formally  accept  the  gift. 

Why  can't  the  independent  medical  colleges 


of  Baltimore  come  together?  Such  an  event 
would  accrue  to  the  best  interests  of  all  con- 
cerned, and  would  greatly  tend  to  eliminate 
Baltimore  as  one  of  the  dark  spots  upon  the 
medical  educational  horizon. 


NURSES  WIN  DIPLOMAS. 

In  spotless  white  and  amid  a  bower  of  flowers. 
10  pretty  young  women  were  handed  their  di- 
plomas yesterday  as  graduates  of  the  Lhiiversity 
Hospital  School  for  Nurses  by  the  Dean,  Prof. 
R.  Dorsey  Coale.  There  were  17  nurses  to  grad- 
uate this  year,  but  one  of  them.  Miss  Catherine 
M.  Dukes,  is  seriously  ill  and  could  not  attend. 

After  the  conferring  of  degrees  Dr.  Arthur  M. 
Shipley  gave  the  young  nurses  advice  as  to  their 
future.  The  opening  prayer  was  delivered  by 
Rev.  Edwin  1'..  Niver,  rector  of  Christ  Protestant 
Episcopal  Church,  and  benediction  was  pro- 
nounced by  Rev.  Dr.  Hemsley,  of  Oakland.  Md. 

The  hall  of  the  University  was  crowded  with 
friends  and  relatives  of  the  graduates.  It  was 
decorated  with  carnations  and  potted  palms,  and 
around  the  pillars  was  twined  black  and  red  bunt- 
ing, the  University  colors.  The  nurses,  preceded 
by  Professor  Coale  and  Dr.  Shipley,  entered  tin.' 
hall  in  pairs,  carrying  bouquets  of  Marguerites. 

Dr.  Shipley  said  that  much  of  the  nurses'  train- 
ing had  been  under  his  supervision,  and  he  felt  a 
personal  interest  in  them.  Women,  he  said,  in- 
variably scared  him,  but  someone  informed  the 
physician  that  was  not  always  so,  for  Dr.  Shipley 
is  to  become  a  benedict  today. 

"You  have  chosen  a  work  that  is  second  to 
none  in  the  world."  said  Dr.  Shipley.  "You  have 
before  you  possibilities  that  are  almost  limitless. 
You  are  on  the  threshold  of  a  life  that  is  to  be  of 
your  own  making,  for  the  chief  danger  of  the  in- 
dividual nurse  is  drifting.  It  is  so  easy  to  forget 
the  old-time  standards  and  call  them  old-fash- 
ioned. <  )ld-fashioned  they  may  be,  but  they  have 
stood  the  test  of  generations  of  correct  living  and 
thinking." 

At  night  the  graduates  were  given  a  farewell 
reception  and  dance  by  the  undergraduates. 


THE    HOSPITAL    BULLETIN 


57 


Dispensary  Report,  April,  igc8,  to  April,  1909. 

OF 

UNIVERSITY   HOSPITAL 

Department.                      New  Cases.  I  H.l  Case; 

Surgical    1 .703  4-44s 

Medical     1.709  3.199 

Genito    Urinary 765  2-933 

Nervous     399  I-'»7| 

Women     733  '-'79 

Stomach    4-i  I.'oS 

Throat  and  Nose '>->->  1.039 

Children     7'>r  997 

Eye   and    Mar 7'^  9°3 

Skin    473  907 

Tuberculosis     190  703 

(  Irthopedic    31  T-° 

8.519  19,609 
Total  new  cases..        8,519 
Total  old  eases.  .  .  .    19.609 

Grand    total jN.128 

JOHN   HOUFF,  M.  D., 

Dispensary  Physician. 


DISPENSARY   PHYSICIANS   AND   CHIEFS 
OF  CLINIC. 

Medical  Department — Dr.  J.  M.  Craighill.  Chief  of 
Clinic;  Drs.  W.  II.  Smith.  G.  C.  Lockard,  .1.  F. 
O'Mara,  R.  C.  Metzel,  11.  J.  Maldeis,  A.  B.  Hayes, 
II.  D.  McCarty,  E.  S.  Perkins.  J.  I'.  Adams.  II.  1.. 
Sinsky,  Clarke.  Todd. 

Surgical  Department — Dr.  John  G.  Jay,  Chi.  I  ol 
Clinic;  Drs.  M.  T.  Cromwell.  T.  A.  Tompkins,  Jr., 
J.  F.  Adams.  J.  II.  Smith.  R.   I'..  Hayes. 

Stomach  Department — Dr  R.  A.  Warner.  Chief  of 
Clinic;  Dr.  W.  W.  Eichenberger. 

Nervous  Department — Dr.  J.  F.  Hawkins.  Chief; 
Drs.  G.  M.  Settle,  F.  .1.  Wilkins,  X.  M.  Owensby. 

Throat  and  Nose  Department — Dr.  II.  C.  Davis, 
Chief  of  Clinic;  Dr.  L.  J.  Goldbach. 

Eye  and  Ear  Department — Dr.  E.  E.  Gibbons, 
Chief  of  Clinic;   Dr.  Win.  Tarun. 

Women  Department — Dr.  Win.  I\.  White.  Chief  of 
Clinic;  Drs.  II.  W.  Brent,  E.  S.  Perkins,  R.  L. 
Mitchell. 

Genito  Urinary  Department — Dr.  Wm.  D.  Scott. 
Jr..  Chief. 

Skin  Department — Dr.  J.  R.  Abercrombie,  Chief. 

Children's  Department — Dr.  A.  1!.  Lcnnan.  Chief; 
Dr.  H.  Schoenrich. 

Tuberculosis  Department — Dr.  Gordon  Wilson, 
Chief. 

Orthopedic  Department — Dr.  Compton  Riely. 
Chief:   Dr.   S.   Demarco. 

JOHN  HOUFF.  M.  D.. 

Dispensary  Physician. 


MARRIAGES. 
Dr.  Win.  B.  Warthen,  class  of  1905,  of  Bar- 
tow, Ga.,  an  ex-resident  gynecologist  jn  the 
University  Hospital,  and  one  of  the  most  pop- 
ular members  of  his  class,  a  hale  fellow  and 
one  of  the  most  loyal  alumni  of  the  University 
of  Maryland,  was  married  at  Macon,  Ga.,  April 
15,  1909,  to  Mrs.  Sallie  Bell  Xewsom,  of  Davis- 
boro,  Ga.  The  Bulletin  and  friends  of  Dr. 
Warthen  extend  to  him  their  best  wishes  for  a 
long,  successful  and  happy  marriage. 


Mrs.  Lavinia  E.  Thomas  has  issued  cards  an- 
nouncing the  marriage  of  her  daughter,  Miss 
Alice  Saunders  Thomas,  to  Dr.  Edward  Bar- 
ney Smith,  class  of  1907,  on  April  21st,  1909,  at 
Creeds.  Virginia.  Dr.  and  Mrs.  Smith  will  be 
at  home  after  May  1,  i90<j,  at  VVoodleigh,  X.  C. 


The  marriage  of  Miss  Helen  Ashby, 
daughter  of  Prof.  Thomas  A.  Ashby  and  Mrs. 
Ashby.  to  Mr.  Harry  J".  Giddings,  of  Baltimore, 
took  place  April  28,  1909,  at  the  residence  of 
her  parents,  112=5  Madison  avenue,  Baltimoie. 


Miss  Edna  Wright,  only  daughter  of  Mr. 
K.  J.  Wright,  a  prominent  merchant  of  llur- 
lock,  Mel.,  and  Dr.  G.  Roger  Myers,  a  well- 
known  physician  of  Hurlock,  were  married 
Wednesday  afternoon,  April  28,  1909,  at  the 
home  of  the  groom's  parents.  Rev.  L.  F.  M. 
Myers,  of  Philadelphia,  a  brother  of  the  groom, 
officiated  at  the  ceremony.  After  a  honeymoon 
spent  at  Atlantic  City  and  other  Northern 
points  of  interest,  the  couple  will  make  their 
home  at  1 1  urli  ick. 


Miss  Julia  C.  Cherbonnier,  of  Baltimore,  and 
Dr.  Eugene  F.  Raphel,  class  of  1906,  of  Wheel- 
ing, were  married  at  St.  Ann's  Catholic  Church 
March  12.  1909.  by  Rev.  C.  F.  Thomas,  assisted 
by  Rev.  Win.  M.  Clements.  The  bride  was 
given  in  marriage  by  her  father,  Capt.  A.  V. 
Cherbonnier.  Her  maid  of  honor  was  Miss 
Jeannefte  Raphel,  sister  of  the  groom.  The 
groom  was  attended  by  his  brother,  Alexis  A. 
Raphel.  Among  the  ushers  were  Dr.  J.  Holmes 
Smith,  Jr.  Dr.  and  Mrs.  Raphel  will  make  their 
home  at  Wheeling.  W.  Ya. 


Dr.  Arthur  Marriott  Shipley,  class  of  1902, 
lor  a  number  of  years  assistant  resident  sur- 
geon, ana  later  superintendent  of  the   I  niver- 


58 


THE   HOSPITAL  BULLETIN 


sity  Hospital,  now  associate  professor  of  sur- 
gery, University  of  Maryland,  was  married 
May  6,  1908,  at  Eutaw  Place  Baptist  Church, 
at  8.30  P.  M.,  to  Miss  Julia  Armistead  Joynes, 
daughter  of  Mr.  Tully  Armistead  Joynes,  of 
Baltimore. 


New  Mexico,  April  13,  1909,  from  pneumonia, 
aged  forty-nine. 


DEATHS. 


Dr.  Hugh  A.  Maughlin,  class  of  1864,  of  Bal- 
timore, died  Saturday,  April  17,  1909,  at  his 
home,  121  North  Broadway,  Baltimore.  Dr. 
Maughlin  was  a  prominent  member  of  the 
Grand  Army  of  the  Republic.  Rev.  J.  Wynne 
Tones,  pastor  of  Abbott  Memorial  Church, 
Highlandtown,  who  is  the  chaplain  of  Wilson 
Post,  of  which  Dr.  Maughlin  was  a  member, 
conducted  the  funeral  services.  Burial  was  in 
Greenmount  Cemetery. 


Dr.  Newton  Clark  Stevens,  class  of  1875,  a 
member  of  the  Louisiana  State  Medical  Soci- 
ety, died  at  his  home,  in  Ama,  January  28,  1909, 
agred  62. 


Dr.  Howard  E.  Mitchell,  class  of  1882,  of 
Ellerslie,  Md.,  died  at  the  Western  Maryland 
Hospital,  Cumberland,  Md.,  April  6,  1909,  48 
hours  after  having  been  struck  by  a  train,  aged 
fifty-four. 


Recently  at  Cavite,  Philippine  Islands,  Mrs. 
Mary  Gibbs  Morris,  wife  of  Dr.  Lewis  Morris, 
class  of  1890,  surgeon  United  States  Navy,  was 
gathered  unto  her  father.  Her  husband  was 
born  in  Baltimore,  and  is  the  son  of  the  late 
Capt.  C.  Manigault  Morris,  commander  of  the 
Florida,  Confederate  States  Navy. 


Dr.  William  Hungerford  Burr,  class  of  1884, 
a  member  of  the  American  Medical  Associa- 
tion, for  four  years  surgeon  in  charge  of  the 
Santa  Fe  System  Hospital  and  surgeon  to  the 
Clark  Coal  Company,  Gallup,  New  Mexico, 
died   in   the   Santa   Fe   Hospital,   Albuquerque, 


Dr.  Edgar  T.  Duke,  one  of  the  most  promi- 
nent physicians  of  Allegany  county,  died  April 
3  at  his  home,  on  Bedford  street,  Cumberland, 
the  result  of  an  attack  of  pneumonia.  He  was 
43  years  old,  a  son  of  Major  and  Mrs.  J.  E. 
Duke,  and  was  a  native  of  Charlestown,  W. 
Va.,  coming  to  Cumberland  with  his  parents 
when  a  young  man.  He  studied  pharmacy 
with  the  late  Dr.  John  F.  Zacharias,  and  later 
read  medicine  under  the  late  Lr.  G.  Ellis  Por- 
ter at  Lonaconing,  graduating  at  the  Univer- 
sity of  Maryland  in  the  class  of  1891. 

Dr.  Duke  was  in  love  with  his  profession, 
and  was  for  a  number  of  years  secretary  of  the 
Allegany  County  Medical  Association.  He  was 
prominent  before  the  association  for  his  special 
papers,  and  was  also  prominent  on  the  church 
lecture  platform.  Hardly  a  church  in  Cumber- 
land but  that  has  had  Dr.  Duke's  services. 

He  was  a  member  of  Chosen  Friends'  Lodge, 
No.  34,  Independent  Order  of  Odd  Fellows,  of 
which  body  he  was  secretary  for  some  years, 
and  also  a  past  presiding  officer,  and  was  con- 
nected with  other  fraternal  organizations. 

Dr.  Duke  was  also  a  member  of  the  Ameri- 
can Medical  Association,  the  Medical  and  Chi- 
rurgical  Faculty  of  Maryland  and  the  Tristate 
Medical  Association.  He  assisted  in  organiz- 
ing the  Western  Maryland  Hospital  Training 
School  for  Nurses  and  was  one  of  the  lecturers. 
He  was  an  elder  and  the  Sunday  school  super- 
intendent in  the  Presbyterian  Church. 

He  was  noted  for  his  kindness.  He  was  also 
active  in  the  Young  Men's  Christian  Associa- 
tion and  was  chairman  of  the  boys'  work  com- 
mittee. His  father  is  a  prominent  Confederate 
veteran.  His  funeral  took  place  Thursday  aft- 
ernoon, April  15,  from  the  First  Presbyterian 
Church.  At  the  present  time  Dr.  Duke's  aged 
mother  is  very  ill. 

Dr.  Duke  leaves  a  widow,  formerly  Miss 
Gardner;  his  parents,  one  brother,  Mr.  Harry 


THE   HOSPITAL  BULLETIN 


55» 


K.  Duke,  and  one  sister,  Mrs.  Mary  Campbell, 
all  of  Cumberland. 


Dr.  Edward  Pontney  Irons,  an  alumnus  of 
the  University  of  Maryland,  and  one  of  the  old- 
est physicians  in  the  city,  died  Sunday,  April  4, 
1909,  at  the  home  of  his  sister,  Mrs.  William  P. 
Lowry,  1023  Harlem  avenue.  He  was  84  years 
old. 

He  was  born  in  this  city,  a  son  of  Dr.  James 
and  Rebecca  Irons,  who  were  of  English  and 
French-Irish  ancestry,  and  descendants  of  the 
earlier  settlers  of  the  state.  He  entered  busi- 
ness and  was  variously  employed  in  a  number 
of  the  Southern  States.  In  1863  he  returned  to 
this  city  and  entered  the  University  of  Mary- 
land. 

After  graduation  in  1865,  when  the  Civil 
War  was  nearing  its  end,  he  acted  as  assistant 
surgeon  in  the  Officers'  Hospital  at  Annapolis. 
A  year  later  he  went  to  Alabama,  but  remained 
only  a  short  time.  He  returned  and  opened  a 
practice  here,  which  he  maintained. 

He  retired  from  active  work  about  seven 
years  ago.  At  that  time  he  was  subordinate 
medical  examiner  for  the  Royal  Arcanum,  of 
which  he  was  a  member.  He  was  also  a  mem- 
ber of  the  Masons,  the  Baltimore  Medical  So- 
ciety and  the  Medical  and  Chirurgical  Faculty 
of  Maryland. 

In  1857  he  married  Miss  Anna  Rebecca  Sew- 
ell,  a  daughter  of  Thomas  H.  Sewell,  a  Balti- 
more manufacturer.  A  daughter,  Mrs.  James 
W.  Ramsey,  is  the  only  survivor. 


Dr.  George  C.  Farnandas,  class  of  1852,  of 
Baltimore,  died  Sunday,  April  4,  1909,  at  his 
home,  1721  Maryland  avenue,  Baltimore,  of  old 
age.  The  funeral  took  place  from  his  late 
home,  1721  Maryland  avenue.  Dr.  Farnandas 
was  80  years  old.  Before  the  Civil  War  he  had 
a  large  practice,  but  gave  it  up  so  that  he  might 
travel.  He  was  well  known  to  the  older  gen- 
eration of  Baltimoreans.  The  services  were 
conducted  by  Rev.  J.  H.  Eccleston.  rector  of 
Emmanuel  Church. 

The  honorary  pallbearers  were  Dr.  N.  K. 
Keirle,  Dr.  James  M.  Craighill,  Dr.  Samuel  T. 
Earle,  Mr.  Thomas  H.  Robinson  and  Mr.  Wm. 
P.  Trimble,  of  Harford  county.  Burial  was  in 
Greenmount  Cemetery. 


Dr.  Benjamin  Franklin  Laughlin,  class  of 
1904,  died  at  his  home,  at  Deer  Park,  Md.,  aged 
31  years.  He  first  located  at  Blaine,  W.  Va., 
where  he  practiced.  He  was  taken  ill  at  King- 
wood,  W.  Va.,  some  months  ago,  and  was  later 
sent  to  a  Baltimore  hospital,  but  he  showed  no 
signs  of  improvement.  He  was  a  son  of  Dr. 
and  Mrs.  J.  W.  Laughlin,  Deer  Park,  and  a 
brother  of  Hice  Laughlin,  a  prominent  Balti- 
more and  Ohio  official,  Grafton,  W.  Va. 


Mrs.  Virginia  Blackwell  Carder,  aged  38 
years,  wife  of  Dr.  George  M.  Carder,  class  of 
1891,  of  Cumberland.  Md.,  died  March  17,  1909, 
after  a  struggle  of  two  weeks  against  the  rav- 
ages of  a  mastoid  abscess. 

Mrs.  Carder  was  preparing  to  visit  her  sister, 
Mrs.  Gay  Breton  Leroux,  in  Douglas,  Ga. 

Suddenly  she  was  stricken,  and  when  an  op- 
eration became  necessary  Airs.  Carder  insisted 
that  her  husband,  a  surgeon  who  has  kept  con- 
stant vigil  the  last  two  weeks,  perform  the  op- 
eration. The  operation  was  apparently  very 
successful,  and  Mrs.  Carder  was  improving, 
when  complications  in  the  form  of  typhoid 
fever  set  in.  Prof.  C.  W.  Mitchell,  of  Balti- 
more, and  Drs.  J  .T.  Walker  and  Harry  Hyland 
Kerr,  of  Washington,  were  called  by  Dr.  Car- 
der, and  all  said  everything  possible  was  being 
done  for  her,  but  held  out  no  hope. 

Mrs.  Carder  was  the  daughter  of  Thomas 
Callan,  of  Narrows  Park,  and,  besides  her  hus- 
band, leaves  a  little  son  (Robert  Callan  Car- 
der), two  brothers  (George  S.  Callan,  of  Duf- 
fields,  W.  Va.,  and  Charles  T.  Callan,  of  Little 
Orleans,  Md.),  and  one  sister  (Airs.  Leroux). 
Miss  Mar_\-  L.  Callan,  a  sister,  was  accidentally 
drowned  in  the  Potomac  at  Little  Orleans. 


IN   PNEUMONIA   the    inspired    air   should    be    rich    in    oxygen   and    com- 
paratively  cool,    while    the    surface    of    the    body,    especially    the   thorax, 
should  be  kept  warm,  lest,   becoming'   chilled,   the  action  of  the  phagocytes 
in  their  battle  with  the  pneumocoeci  be  inhibited. 


(Inflammation 's  cAntidote) 

applied  to  the  chest  wall,  front,   sides  and   back,    hot    and  thick,  stimulates  the 
action  of  the  phagocytes  and  often  turns  the  scale  in  favor  of  recovery. 

Croup. —  Instead  of  depending  on  an  emetic  for  quick  action  in 
croup,  the  physician  will  do  well  to  apply  Antiphlogistine  hot  and  thick  from 
ear  to  ear  and  down  over  the  interclavicular  space.  The  results  of  such  treat- 
ment are  usually  prompt  and  gratifying. 

Antiphlogistine  hot  and  thick  is  also  indicated  in  Bronchitis  and  Pleurisy 


The   Denver  Chemical  Mfg.  Co. 


New  York 


ERTAIN  as  it  is  that  a  single  acting  cause  can  bring 
about  any  one  of  the  several  anomalies  of  menstrua- 
tion, just  so  certain  is  it  that  a  single  remedial  agent 
—  if  properly  administered  —  can  effect  the  relief  of 
anv  one  of  those  anomalies. 

<S  The  singular  efficacy  of  Ergoapiol  (Smith)  in  the 
various  menstrual  irregularities  is  manifestly  due  to  its  prompt 
and  direct  analgesic,  antispasmodic  and  tonic  action  upon  the 
entire  female  reproductive  system. 

(§  Ergoapiol  (Smith)  is  of  special,  indeed  extraordinary,  value  in 
such  menstrual  irregularities  as  amenorrhea,  dysmenorrhea, 
menorrhagia  and  metrorrhagia. 

^  The  creators  of  the  preparation,  the  Martin  H.  Smith 
Company,  of  New  York,  will  send  samples  and  exhaustive 
literature,  post  paid,  to  any  member  of  the  medical  profession. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 

PRICE    Sl.OO     PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University. 
Business  Address,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter. 


Vol.  V 


BALTIMORE,   MD.,  JUNE  15,   1909 


No.  4 


A  CLINICAL  STUDY  OF  ECTOPIC  PREG- 
NANCY, WITH  A  REPORT  OF 
FORTY-FIVE  CASES. 

By  Thomas  A.  Ashby,  M  D., 

Professor  of  Diseases  of  Women  in  the  Univer- 
sity of  Maryland,  Baltimore,  Md.;  Fellow  of 
the  American  Gynecological  Society,  etc. 

I  wish  to  relate  my  personal  experience  with 
ectopic  pregnancy  in  order  to  show  from  a  study 
of  45  patients  operated  on  some  points  of  interest 
in  the  clinical  history,  diagnosis  and  treatment  of 
this  condition.  The  number  of  cases  coming 
under  the  observation  of  a  single  operator  is  suf- 
ficient evidence  of  the  frequency  of  the  condition. 
I  wish  to  show  from  a  study  of  my  own  cases 
that  the  clinical  history  of  ectopic  pregnancy  pre- 
sents a  strong  argument  in  favor  of  the  import- 
ance of  prompt  diagnosis  and  radical  treatment 
ofa  dangerous  pathologic  condition.  Whatever 
view  we  may  take  of  the  etiology  of  ectopic  preg- 
nancy, one  important  fact  is  shown  in  the  danger 
which  attends  the  condition.  Whilst  a  failure  to 
interpret  symptoms  and  delay  in  diagnosis  and 
treatment  often  lead  to  unfortunate  results,  it  will 
be  shown  in  this  series  of  cases  that  the  diagnosis 
is  not  usually  made  until  the  patient  has  reached 
the  operating  table,  and  that  the  surgeon  at  times 
is  dealing  with  results  of  long  standing,  and  in 
other  cases  of  immediate  importance. 

My  first  patient  was  operated  on  in  June,  1889, 
my  last  in  May,  1909.  Of  the  45  patients,  44  re- 
covered and  one  died. 

Case  I. — Mrs.  D.,  age  25  years,  married  five 
years,  and  mother  of  one  child,  age  four  years, 
was  referred  to  me  by  her  family  physician,  the 
late  Dr.  George  R.  Graham,  of  Baltimore.  Men- 
struation was  suppressed  two  months.  No  other 
symptoms  of  pregnancy  were  present.  About  the 
tenth  week  after  her  menstruation  had  ceased  she 
was  seized  with  violent  pain  in  the  left  ovarian 
region.  Dr.  Graham  was  called  in,  and  upon  ex- 
amination detected  a  small  movable  tumor  to  the 
left  of  the  uterus  and  very  low  in  the  pelvis.    He 


suspected  a  tubal  pregnancy  and  put  the  patient 
to  bed.  Four  weeks  later  the  patient  was  again 
seized  with  violent  pain  in  the  same  region,  fol- 
lowed by  a  slight  collapse  and  shock.  Upon  ex- 
amination Dr.  Graham  found  that  the  tumor  had 
disappeared.  On  the  following  morning  menstru- 
ation reappeared,  but  the  pain  continued.  Rup- 
tured tubal  pregnancy  was  strongly  suspected.  I 
saw  the  patient  in  consultation  the  following  day. 
An  examination  was  made  under  anesthesia,  but 
no  satisfactory  condition  could  be  made  out  be- 
yond some  slight  indication  of  a  small  movable 
tumor  to  the  left  of  the  uterus  high  up  in  the  pel- 
vis. After  a  few  days  the  patient  was  able  to  re- 
sume her  domestic  duties.  She  was  free  from 
pain  from  April  10,  the  date  of  consultation,  until 
the  first  week  in  June,  when  violent  pains  re- 
turned in  the  same  region.  This  continued  until 
June  10,  when  I  again  saw  her  in  consultation. 
At  this  time  a  small  but  movable  mass  was  felt  in 
the  left  pelvic  region.  As  the  patient  was  in  great 
distress,  an  operation  was  proposed  and  accepted. 
On  June  11  a  celiotomy  was  done  at  the  patient's 
home  and  the  tumor  was  removed.  It  proved  to 
be  the  left  ovary  containing  a  small  blood  clot 
partially  ruptured  into  the  folds  of  the  left  broad 
ligament.    The  patient  made  a  prompt  recovery. 

The  pathologic  report  proved  to  be  most  inter- 
esting. The  specimen  was  examined  for  me  by 
Dr.  W.  H.  Welch,  of  the  Johns  Hopkins  Medical 
School,  who  found  that  it  was  composed  of  the 
lateral  extremity  of  the  Fallopian  tube,  the  ovary, 
a  sac  containing  blood  coagula  and  fetal  mem- 
branes, and  a  unilocular  cyst  with  the  correspond- 
ing part  of  the  ligamentum  latum.  Dr.  Welch's 
report  says :  ''There  is  no  doubt  that  the  case  is 
one  of  ovarian  fetation.  It  is  not  possible  to  ex- 
clude positively  the  participation  of  the  wall  of 
the  tube  in  the  formation  of  the  sac  containing 
fetal  remnants,  so  that  the  case  may  be  possibly 
a  tubo-ovarian  pregnancy." 

The  occurrence  of  ovarian  pregnancy  has  been 
denied  by  the  majority  of  observers  on  the 
ground  of  the  physical  impossibility  of  the  im- 


62 


THE   HOSPITAL  BULLETIN 


pregnated  ovum  being  surrounded  by  ovarian 
tissue.  The  few  cases  reported  can  hardly  be  con- 
sidered as  positively  proven,  and  probably  should 
be  regarded  as  belonging  to  the  tubo-ovarian  va- 
riety, as  shown  in  the  case  here  reported.  This 
variety  must  of  necessity  be  very  rare.  An  early 
termination  of  gestation  is  invited  by  the  physical 
conditions  which  surround  the  impregnated 
ovum.  Danger  from  rupture  of  the  sac  and  hem- 
orrhage should  be  less  than  in  any  other  variety. 

Case  II. — This  patient  was  seen  in  consulta- 
tion with  Dr.  Arthur  Williams,  of  Elk  Ridge, 
Aid.  Mrs.  M.,  aged  30  years,  was  seized  with 
violent  pains  in  the  pelvis,  followed  by  symptoms 
of  collapse.  She  had  the  usual  signs  of  preg- 
nancy advanced  to  the  eighth  or  ninth  week.  Dr. 
Williams  was  called  in.  and  after  examination 
diagnosed  the  case  as  one  of  ruptured  tubal  preg- 
nancy. I  was  invited  to  see  the  patient  in  consul- 
tation, and  confirmed  the  diagnosis.  The  patient 
was  advised  to  go  to  the  Maryland  General  Hos- 
pital for  immediate  operation.  Owing  to  her  con- 
dition and  to  unavoidable  delay  in  moving  her 
from  her  home  in  the  country,  the  operation 
could  not  be  done  for  some  five  days  after  the 
rupture.  In  the  meantime  symptoms  of  infection 
had  supervened  and  the  general  condition  of  the 
patient  was  much  depressed.  When  the  section 
was  made  a  large  hematocele  filled  the  pelvis  ;  the 
left  tube  had  ruptured  and  contained  placental 
debris.  The  blood  and  placenta  were  macerated 
and  semi-decomposed ;  peritonitis,  both  local  and 
general,  had  started  up.  The  pelvis  was  emptied 
of  blood  clots  and  cleaned  as  thoroughly  as  pos- 
sible by  removing  the  damaged  tube  and  other  in- 
fected tissue.  The  operation  presented  a  number 
of  difficulties,  owing  to  the  extent  of  the  hemato- 
cele and  inflammation  of  the  peritoneum,  which 
had  given  rise  to  adhesioAs  and  inflation  of  the 
intestines. 

The  patient  came  out  of  the  operation  with 
great  shock  from  the'  previous  loss  of  blood  and 
from  the  extent  of  the  procedure  instituted  for 
her  relief.  Her  pulse  at  the  time  of  the  operation 
was  135  and  temperature  I02°E.  Rally  from 
shock  was  slow.  General  peritonitis  was  well  es- 
tablished on  the  fourth  day,  the  abdomen  was 
greatly  distended,  nausea  was  extreme,  and 
bowels  were  confined.  The  patient  was  so  ill  that 
her  life  was  despaired  of.  I  decided  that  the  only 
measure  that  could  save  her  was  free  purgation. 
I  gave  her  one  grain  (0.06  gram.)  of  calomel 
everv  hour  for  thirteen  hours.    At  the  end  of  that 


time  her  bowels  began  to  move  and  she  purged 
copiously  until  it  became  necessary  to  use  restora- 
tives. The  free  purgation  soon  relieved  all  of 
her  symptoms,  and  she  began  at  once  to  make 
rapid  progress  toward  recovery. 

This  experience  confirmed  my  faith  in  the 
value  of  calomel  after  abdominal  operations,  and 
from  that  time  to  the  present  T  have  found  it  the 
most  reliable  of  all  drugs  in  post-operative  cases 
when  free  purgation  is  required.  It  has  one  great 
advantage  in  the  fact  that  it  is  not  given  in  bulk- 
ami  is  not  easily  rejected  by  the  stomach.  It  is 
seldom  necessary  to  give  more  than  one  to  three 
grains,  in  quarter,  half  or  one-grain  doses,  at  in- 
tervals of  one  hour,  to  bring  on  a  free  bowel 
movement.  In  this  connection  I  may  mention  the 
value  of  salicylate  of  eserine  in  one-fortieth  of  a 
grain  (0.0015  gram  1  doses  given  hypodermically 
in  cases  of  apparent  bowel  obstruction  following 
abdominal  operations.  Several  recent  experiences 
have  showed  the  marked  efficacy  of  this  new  rem- 
edy, and  have  demonstrated  the  rapidity  of  its 
action.  During  May.  1905.  after  an  operation  for 
the  removal  of  an  ovarian  cyst,  the  patient's 
bowels  refused  to  move,  and  symptoms  of  ob- 
struction were  so  marked  that  a  reopening  of  the 
abdomen  was  seriously  considered.  All  other 
agents  had  failed,  whereupon  I  gave  the  patient  a 
hypodermic  injection  of  one-fortieth  of  a  grain 
of  eserine  salicylate.  In  less  than  thirty  minutes 
a  free  bowel  movement  was  brought  on  and  all 
symptoms  of  obstruction  disappeared.  No  un- 
pleasant effects  followed  the  use  of  the  drug,  and 
subsequent  experiences  have  shown  its  great 
value  in  similar  conditions. 

There  is  no  more  important  condition  in  the 
after-treatment  of  abdominal  operations  than  in- 
testinal torpidity.  This  condition  should  be 
watched  from  the  very  beginning,  and  should  be 
relieved  at  once  if  a  speedy  convalescence  is  de- 
sired. I  make  it  a  rule  to  empty  the  intestines 
freely  before  every  operation  requiring  anes- 
thesia. This  may  obviate  the  necessity  for  an 
early  bowel  movement  after  the  operation,  but  it 
does  not  do  away  with  a  careful  oversight  of  the 
intestinal  condition  which  may  call  for  the  early 
and  free  use  of  purgation.  Observation  will 
show  that  in  the  vast  majority  of  operative  cases, 
when  the  bowels  and  kidneys  are  acting  well 
a  speedy  convalescence  may  be  expected. 

Case  III. — Presents  no  important  clinical 
symptoms. 

Case  IV. — Was  a  widow  of  some  two  years 


THE   HOSPITAL  BULLETIN 


63 


standing.  30  years  of  age,  and  had  not  borne  a 
child.  Pregnancy  was  not  suspected.  When  I 
was  called  to  see  her  I  found  her  critically  ill  with 
sepsis.  Her  pelvis  was  filled  with  a  large  mass 
which  I  assumed  was  a  pus  accumulation.  An  im- 
mediate operation  was  advised,  but  over  twenty- 
four  hours'  delay  occurred  in  getting  the  consent 
of  her  friends  and  in  removing  her  to  the  hos- 
pital where  the  operation  could  be  done.  The 
patient's  condition  grew  alarming  in  this  interim. 
When  the  section  was  made  a  large  encysted  he- 
matocele, with  ruptured  tube  containing  placental 
debris,  at  once  explained  the  etiology  of  the  in- 
flammatory condition  and  the  origin  of  the  sys- 
temic infection.  General  peritonitis  and  sepsis 
were  well  under  way  when  the  abdomen  was 
opened.  The  intrapelvic  condition  was  removed 
as  thoroughly  as  possible,  but  it  was  too  late  to 
arrest  the  blood  infection,  which  destroyed  her 
life  on  the  fourth  day  after  the  operation.  The 
social  position  of  this  patient  misled  her  physician 
in  arriving  at  a  prompt  diagnosis  in  the  early 
stage  of  the  attack.  The  rupture  of  the  tube  and 
the  hematocele  most  probably  took  place  a  few 
days  before  he  was  called  in.  He  had  no  way  of 
knowing  the  etiology  of  her  condition,  and  was 
forced  to  treat  it  as  an  ordinary  intrapelvic  inflam- 
mation. The  patient  found  it  necessary  to  con- 
ceal her  true  condition  from  her  friends  and  from 
her  physician,  and  it  was  not  discovered  until  she 
was  on  the  operating  table.  Her  friends  have  no 
knowledge  of  the  primary  cause  of  her  death. 

Casks  Y.  and  VI. — Presented  the  ordinary 
physical  signs  of  intrapelvic  hematocele,  and 
when  the  abdomen  was  opened  the  origin  of  the 
hematocele  was  found  in  a  ruptured  tube  with  the 
usual  changes  indicating  the  beginning  of  tubal 
gestation.  Rupture  occurred  in  the  early  weeks 
of  gestation,  and  the  remnants  of  fetal  life  had 
disappeared  with  the  exception  of  the  placental 
debris.  Both  patients  made  uneventful  recov- 
eries. 

Case  VII. — Presented  the  history  of  pregnancy 
advanced  to  the  twelfth  week.  Symptoms  of  pri- 
mary rupture  were  not  present,  but  the  physical 
signs  pointed  to  tubal  gestation.  A  positive  diag- 
nosis was  made  and  the  abdomen  opened  in  an- 
ticipation of  a  possible  rupture  at  any  moment. 
The  left  tube  was  removed,  being  enlarged  and 
distended  with  the  placenta  and  embryo  advanced 
to  the  third  month  of  development.  The  tube 
wall  was  so  thin  from  distension  that  in  the  ma- 
nipulations   connected    with   its   removal    it   rup- 


tured and  expelled  a  living  fetus.  Primary  rup- 
ture would  undoubtedly  have  occurred  within  a 
few  days  had  not  the  section  been  made.  A 
prompt  diagnosis  and  removal  of  the  tube  prior 
to  rupture  made  the  operation  a  very  simple  pro- 
cedure, and  the  recovery  of  the  patient  brought  a 
prompt  conclusion  to  her  invalidism. 

Case  VIII.. — Presents  no  unusual  clinical 
symptoms.  This  case  was  the  only  one  in  this 
series  of  45  cases  treated  by  the  vaginal  route. 

Case  IX. — The  diagnosis  of  pregnancy  was 
not  positive.  The  physical  signs  were  those  of  a 
large  intrapelvic  tumor  most  probably  of  fetal  or- 
igin. L'pon  abdominal  section  a  ruptured  tube 
was  found  with  a  ten  weeks'  fetus,  covered  up  in 
the  debris.  The  case  presented  no  history  of  rup- 
ture, such  as  pain,  collapse  or  shock.  The  leakage 
from  the  ruptured  tube  was  small  and  indications 
of  absorption  of  the  blood  clot  were  quite  mani- 
fest. It  is  probable  that  a  long  delay  in  operat- 
ing would  have  led  to  an  almost  total  removal  of 
the  blood,  and  to  an  encysted  condition  of  the 
fetus,  as  no  evidences  of  infection  were  present. 
With  the  removal  of  the  tube  and  debris  the 
patient  made  a  prompt  recovery. 

This  case  illustrates  the  probable  behavior  of  a 
class  of  cases  in  which  nature  is  successful  in  re- 
moving the  debris  of  a  tubal  rupture  and  in  dis- 
posing of  the  fetus  through  either  gradual  ab- 
sorption or  by  enclosing  it  in  a  distinct  sac,  where 
it  may  remain  buried  in  the  tissues  for  years.  In 
Case  XVIII.  of  this  series  there  is  a  history  of 
this  condition  in  which  the  fetal  bones  finally 
worked  through  the  wall  of  the  abdomen  and  led 
to  an  infection  of  the  sinus  leading  down  to  the 
bed  in  which  the  fetal  remnants  were  encysted. 
It  is  interesting  to  observe  how  nature  attempts 
to  deal  with  these  foreign  bodies,  and  with  what 
success  when  infection  is  not  present.  The  early 
rupture  of  the  tube  may  no  doubt  take  place  in 
many  cases  with  complete  recovery  and  final  dis- 
appearance of  the  products  of  conception,  and  in 
this  manner  explain  how  it  is  that  pelvic  hem- 
atoceles often  go  on  to  complete  absorption  and 
disappearance. 

Case  X. — This  patient  presents  no  important 
points  for  study. 

Case  XI. — Upon  examination  a  tumor  the  size 
of  a  baseball  was  found  in  the  left  ovarian  region. 
She  presented  a  history  of  pregnancy  of  some 
eight  weeks'  duration.  The  diagnosis  of  tubal 
pregnancy  was  made  and  she  was  advised  to  go  to 
the  hospital   for  immediate  operation,  as  symp- 


64 


THE   HOSPITAL  BULLETIN 


toms  of  rupture  were  indicated  by  colicky  pains 
simulating  those  of  uterine  colic.  She  was  ad- 
mitted to  the  hospital  late  at  night  and  was  pre- 
pared for  an  early  operation.  When  the  abdomen 
was  opened  at  10.30  o'clock  the  next  morning  the 
tube  was  found  ruptured  and  a  small  fetus  of  not 
over  seven  or  eight  weeks'  development  was 
found  half-way  expelled  through  a  rupture  in  the 
tube  which  probably  occurred  only  an  hour  or 
two  before  operation.  A  small  vessel  at  the  seat 
of  the  rupture  was  discharging  arterial  blood  into 
the  abdominal  cavity,  which  contained  some  ten 
or  twelve  ounces.  The  patient  had  already  be- 
come blanched  and  weak  from  loss  of  blood  from 
the  upper  surface  of  the  tube,  the  most  dangerous 
point  where  rupture  could  occur.  A  ligature  was 
thrown  around  the  tube  close  to  the  uterus  and 
the  tumor  mass  removed.  But  for  the  prompt- 
ness of  the  operation  this  patient  would  have  per- 
ished from  a  concealed  hemorrhage. 

The  case  demonstrates  one  of  the  great  dangers 
of  primary  rupture  with  leakage  into  the  general 
abdominal  cavity,  and  the  treacherous  nature  of 
tubal  gestation.  In  the  absence  of  an  abdominal 
section  primary  rupture  of  the  tube  cannot  be 
considered  otherwise  than  hazardous,  since  in  the 
absence  of  operation  the  physician  in  attendance 
can  form  no  opinion  as  to  the  location  of  the  rup- 
ture and  possible  limit  of  hemorrhage.  The 
symptoms  of  collapse  and  shock  may  give  some 
indication  of  the  necessity  f®r  immediate  action, 
but  these  symptoms  are  not  reliable  and  can  sel- 
dom be  trusted.  A  secondary  rupture  usually  in- 
dicates an  encysted  form  of  hematocele — by  far 
the  most  common  form  of  tubal  leakage,  as  is 
shown  by  this  series  of  cases.  It  is  probable  that 
the  primary  rupture  into  the  general  abdominal 
cavity  leads  to  death  in  the  larger  number  of  cases 
before  the  symptoms  of  pregnancy  are  observed, 
and  in  this  way  we  may  account  for  the  sudden 
deaths  which  are  now  and  then  observed  from 
concealed  hemorrhage,  and  in  which  an  autopsy 
is  not  made  to  clear  up  the  cause  of  death. 

This  case  teaches  the  important  lesson  that  tu- 
bal gestation  is  not  an  innocent  condition,  and 
that  when  the  condition  is  recognized  before  rup- 
ture has  taken  place  an  immediate  operation 
should  be  done  to  remove  the  treacherous  tube. 
No  confidence  can  be  placed  in  nature's  method 
of  dealing  with  ectopic  gestation,  either  before  or 
after  rupture  has  occurred.  The  fact  that  we  find 
in  intra-abdominal  work  such  a  large  number  of 
old  hematoceles  of  tubal  origin,  showing  a  partial 


escape  from  the  consequences  of  rupture  and 
leakage,  cannot  be  used  as  an  argument  in  sup- 
port of  delay  when  a  diagnosis  of  ectopic  preg- 
nancy has  been  made.  An  immediate  explora- 
tory section  to  establish  a  diagnosis  in  a  suspected 
case  would  be  less  hazardous  than  the  expectant 
line  of  treatment. 

Case  XII. — This  patient  presented  the  usual 
symptoms  of  pregnancy — suppression  of  men- 
struation, enlargement  of  the  breasts,  morning 
sickness,  and  slight  increase  in  the  size  of  the 
uterus.  Upon  examining  her  pelvis  a  large  tu- 
mor, presenting  the  signs  of  an  enlarged  tube, 
was  found  in  the  left  pelvic  region.  The  diag- 
nosis of  left  tubal  gestation  was  made.  No  indi- 
cations of  a  threatened  tubal  rupture  were  pres- 
ent, but  it  was  decided  to  operate  at  once  and 
forestall  such  an  occurrence.  Upon  opening  the 
abdomen  in  the  median  line  the  tumor  was  easily 
reached  and  drawn  out  through  the  incision.  In 
the  manipulation  attending  the  withdrawal  of  the 
tube  it  ruptured  and  a  small  living  fetus  was  ex- 
pelled. The  tube  was  tied  off  close  to  the  uterus 
and  removed.  The  operation  required  only  a  few 
minutes  and  was  attended  with  but  little  loss  of 
blood.  The  recovery  of  the  patient  was  une- 
ventful. 

Cases  XIII.  and  XIV. — Present  no  unusual 
clinical  features. 

Case  XV. — Mrs.  M.,  the  mother  of  four  chil- 
dren, presented  all  the  rational  signs  of  preg- 
nancy. Nausea  and  vomiting  were  incessant  and 
continued  for  several  weeks,  until  emaciation  and 
depression  were  extreme.  An  examination  of  the 
pelvis  was  then  made  to  determine  the  condition 
of  the  uterus,  but  nothing  satisfactory  was  re- 
vealed. At  this  time  the  gestation  was  believed 
to  be  normal.  During  the  third  week  the  nausea 
suddenly  ceased  and  the  patient  began  to  take 
nourishment.  The  patient  then  had  a  rise  of  tem- 
perature, followed  by  symptoms  of  intrapelvic  in- 
flammation. There  were  no  symptoms  of  tubal 
rupture,  but  the  sudden  arrest  of  nausea,  and  de- 
velopment of  intrapelvic  inflammation,  led  to  the 
opinion  that  the  gestation  had  been  arrested  and 
its  tubal  origin  was  strongly  suspected.  This 
led  to  a  careful  examination  under  anesthesia, 
when  a  small  mass  in  the  left  ovarian  region 
was  discovered.  The  uterus  was  only  slightly 
increased  in  size.  Tubal  pregnancy  was  so 
strongly  suspected  that  it  was  decided  to  open 
the  abdomen  on  the  following  day.  When  the 
section  was  made  the  left  tube  was  found  en- 


THE   HOSPITAL   BULLETIN 


65 


larged  to  the  size  of  a  hen's  egg.  In  the  canal 
of  the  tube  was  a  small  gestation  sac  unrup- 
tured, but  containing  only  placental  tissue. 
Fetal  death  had  occurred  so  early  that  its  ab- 
sorption was  complete.  A  mild  infection  had 
begun  in  the  tube,  and  this  no  doubt  had  caused 
the  rise  of  temperature.  With  the  removal  of 
the  tube  the  patient  was  soon  restored  to 
health. 

In  this  patient  there  was  an  unusual  disturb- 
ance of  her  digestive  organs  following  concep- 
tion, but  this  subsided  with  the  death  of  the 
embryo.  But  for  an  infection  of  the  tube  con- 
taining the  fetal  remains  a  complete  subsidence 
of  the  trouble  would  probably  have  taken  place. 
It  is  interesting  to  inquire  whether  an  infection 
of  the  tube  brought  about  an  arrest  of  the  ges- 
tation or  followed  in  the  wake  of  the  embryo's 
death?  Could  this  question  be  answered  in  the 
affirmative  it  might  explain  how  the  death  of 
the  embryo  is  brought  about  in  the  first  few 
weeks  of  gestation  in  certain  cases. 

Case  XVI.— -Mrs.  B.,  a  multipara,  age  35 
years,  was  admitted  to  the  University  Hospital 
from  North  Carolina.  At  the  time  of  her  ad- 
mission she  was  critically  ill  with  an  acute  in- 
trapelvic  inflammation,  the  origin  of  which 
could  not  be  explained  by  her  history.  A  large 
mass  filled  the  pelvis  and  presented  all  the 
physical  signs  of  an  acute  salpingitis.  An  ab- 
dominal section  was  made  as  soon  as  the 
patient  could  be  prepared  for  the  operation. 
The  mass  was  found  to  be  a  large  encysted 
hematocele,  due  to  a  ruptured  tube,  induced  by 
the  overdistension  of  placental  tissue  and  blood 
clots.  Infection  had  taken  place  and  the  pelvic 
cavity  and  contents  were  actively  inflamed.  The 
entire  mass  was  removed  and  the  abdomen 
closed.  The  subsequent  condition  of  the  patient 
was  satisfactory  until  the  tenth  day,  when  her 
temperature  began  to  go  up  and  down  in  an  er- 
ratic way.  An  examination  of  the  pelvis  and 
of  the  abdominal  wound  showed  complete  re- 
pair and  not  the  slightest  signs  of  infection. 
Finding  in  her  surgical  condition  no  explanation 
for  the  temperature  changes,  I  suspected  a  ty- 
phoid infection,  and  blood  examinations  re- 
vealed a  typical  Widal  reaction.  For  the  fol- 
lowing fifteen  weeks  the  patient  ran  the  course 
of  typhoid  fever,  and,  though  much  reduced 
physically,  eventually  recovered.  I  am  unable 
to  explain  the  occurrence  of  the  typhoid  infec- 
tion in  connection  with  a  tubal  gestation  except 


upon  the  theory  that  the  tubal  condition  was 
of  long  standing  and  the  typhoid  infection  had 
rekindled  a  tubal  inflammation,  which  at  once 
called  attention  to  the  intrapelvic  condition  for 
which  the  section  was  done.  The  removal  of 
the  tubal  condition  had  little  influence  over  the 
typhoid  infection,  which  ran  a  typical  course. 
But  for  the  removal  of  the  diseased  tube  I  be- 
lieve the  patient  would  have  lost  her  life. 

Case  XVII. — This  patient,  a  colored  woman, 
about  35  years  of  age,  was  admitted  to  the  Uni- 
versity Hospital  to  be  treated  for  a  large  intra- 
abdominal tumor  which  was  solid  in  character 
and  freely  movable.  It  was  attached  to  the 
uterus  by  a  long  pedicle,  and  in  its  physical  as- 
pects seemed  to  be  a  solid  tumor  of  the  ovary, 
or  a  subperitoneal  fibroid  with  an  elongated 
pedicle.  There  was  no  history  of  pregnancy 
and  this  condition  was  not  considered.  When 
the  abdomen  was  opened  the  true  character  of 
the  tumor  was  made  out.  It  was  found  to  be  a 
greatly  enlarged  left  tube  with  the  fetus  partly 
expelled  from  the  fimbriated  end.  The  tube 
was  attached  to  the  uterus  by  a  pedicle  over  six 
inches  in  length,  the  whole  mass  being  so  freely 
movable  that  it  was  easily  withdrawn  through 
the  abdominal  incision  and  detached  from  the 
uterus.  The  operation  for  its  removal  took 
only  a  few  minutes. 

This  pathological  finding  is  the  most  interest- 
ing of  this  series  of  cases,  since  it  explains  the 
manner  in  which  tubal  abortions  take  place  and 
how  the  tubal  variety  is  converted  into  the  ab- 
dominal variety.  The  body  of  a  dead  fetus  was 
enclosed  in  the  cavity  of  a  large  tube,  whilst 
the  head  of  the  fetus,  covered  with  the  amnion, 
has  been  expelled,  the  neck  being  tightly 
grasped  by  the  open  end  of  the  tube.  Before 
the  fetus  perished  the  tube  had  attempted  to 
expel  it  into  the  abdominal  cavity,  and  had  its 
expulsion  been  complete,  and  the  fetus  still 
viable,  the  development  continuing,  the  abdom- 
inal variety  of  pregnancy  would  have  resulted. 
As  it  happened,  the  fetus  probably  perished  be- 
fore its  complete  expulsion  was  accomplished, 
and  the  expulsive  power  of  the  tube  was  so 
weakened  by  the  arrest  of  fetal  growth  that  it 
remained  in  the  condition  in  which  it  was  found 
at  the  time  the  abdomen  was  opened.  Just  how 
long  the  patient  had  carried  this  dead  fetus  I 
was  unable  to  determine,  but  from  her  some- 
what indefinite  statement  as  to  the  presence  of 
the  tumor  I  am  led  to  believe  that  more  than 


66 


THE    HOSPITAL   BULLETIN 


six  months  had  intervened  from  the  time  she 
first  observed  it  to  the  time  of  the  operation. 
Fortunately,  the  fetus  was  so  hermetically 
sealed  up  in  the  abdomen  that  infection  did  not 
take  place,  and  there  was  no  evidence  of  ab- 
sorption. It  was  dead,  but  well  preserved. 
There  had  been  some  slight  escape  of  blood 
into  the  abdomen — shown  by  the  discoloration 
of  the  tissues  and  a  few  flakes  of  lymph  scat- 
tered here  and  there.  The  freedom  with  which 
the  tumor  could  be  moved  was  probably  due 
to  the  weight  of  the  mass  on  the  uterine  end  of 
the  tube,  which  had  elongated  by  traction. 

The  origin  of  the  abdominal  variety  of  ectopic 
pregnancy  has  been  so  fully  establishd  that  but 
few  cases  can  be  referred  to  any  other  seat  of 
development  than  the  cavity  of  the  tube.  This 
case  so  beautifully  shows  how  the  tubal  variety 
is  converted  into  the  abdominal  variety  that  a 
positive  demonstration  may  be  claimed. 

Case  XVIII. — This  patient  was  a  multipara, 
aged  30  years,  admitted  to  the  University  Hos- 
pital with  a  small  abscess  sinus  located  in  the 
median  line  midway  between  the  umbilicus  and 
the  symphysis.  There  was  no  history  of  preg- 
nancy and  the  condition  was  not  suspected. 
Upon  physical  examination  a  small  inflamma- 
tory tumor  was  found  in  the  left  pelvic  cavity. 
There  was  some  fixation  of  the  uterus.  Intro- 
ducing a  blunt  probe  into  the  sinus,  it  was 
easily  pushed  down  into  the  pelvis  until  it  had 
reached  the  tumor  mass.  This  sinus  was  found 
acting  as  a  drain  canal  to  the  pelvic  abscess, 
and  had  served  as  a  route  for  the  escape  of 
small  fetal  bones  which  were  buried  in  the 
deeper  tissues.  An  abdominal  section  was  made 
and  the  debris  of  a  small  fetus,  chiefly  bones, 
was  found  buried  in  the  wall  of  the  abdomen 
and  underlying  structures  and  connected  with 
a  ruptured  tube  coming  off  from  the  left  horn 
of  the  uterus. 

The  explanation  of  the  condition  was  now 
made  plain.  This  patient  without  her  knowl- 
edge of  pregnancy  had  carried  a  fetus  in  the 
left  tube  between  eight  and  ten  weeks.  The 
overdistended  tube  had  cast  out  the  fetus  and 
it  had  been  walled  off  from  the  general  abdomi- 
nal cavity  by  a  distinct  sac  wall,  the  sac  subse- 
quently forming  close  attachments  to  the  wall 
of  the  abdomen,  through  which  pus  and  fetal 
bones  finally  made  an  exit.  Here  was  an  intel- 
ligent effort  upon  the  part  of  nature  to  throw 
off  a  dead  fetus  by  the  abdominal  route.     This 


is  the  only  instance  in  this  series  of  cases  in 
which  an  effort  was  made  to  eliminate  the  dead 
fetus  in  this  manner,  and  I  must  assume  that 
there  were  physical  conditions  present  which 
made  this  method  possible.  After  the  removal 
of  the  debris  and  damaged  tube  the  patient  was 
restored  to  good  health. 

Cases  XIX.  XX.,  XXI  and  XXII.— These 
cases  were  operated  on  in  the  University  Hos- 
pital during  the  years  1903  and  1904.  As  they 
were  only  diagnosed  as  ectopic  pregnancy 
on  the  operating  table,  I  shall  refer  to  them 
very  briefly.  In  each  case  the  patient  gave  no 
history  of  pregnancy,  and  there  were  no  symp- 
toms which  could  explain  the  etiology  of  their 
conditions  at  the  time  of  the  operation.  In  each 
the  physical  signs  indicated  chronic  tubo-ova- 
rian  disease.  After  an  abdominal  section  was 
made  and  the  tube  was  exposed  to  view  the 
etiology  of  the  tubal  condition  was  explained. 
In  each  instance  a  ruptured  tube  was  found  and 
placental  remnants  were  present.  Evidences 
of  extensive  hemorrhage  were  not  found,  but 
indications  of  attempted  repair  and  of  chronic 
tissue  changes  were  observed.  These  cases  fol- 
lowing each  other  so  closely  present  a  history 
frequently  overlooked  in  intra-abdominal  work 
— a  history  of  minor  tubal  disease  caused  by  an 
earlyr  arrest  of  a  tubal  gestation  with  an  incom- 
plete repair  of  the  damaged  organ,  followed  by 
svmptoms  of  tubo-ovarian  inflammation. 

In  dealing  with  this  class  of  patients  it  is 
often  fair  to  assume  on  circumstantial  evidence 
much  that  cannot  be  definitely  proved.  These 
women  had  all  been  exposed  to  the  contagion 
of  gonorrhea,  and  no  doubt  had  had  gonorrheal 
salpingitis  of  mild  degrees.  The  arrest  of  an 
infection  may  limit,  but  not  totally  destroy,  the 
function  of  the  tube,  and  thereby  favor  tubal 
conceptions  and  abortions.  On  such  an  assump- 
tion as  this  we  can  explain  the  frequency  of 
tubal  conceptions  and  early  ruptures  when  no 
other  explanation  seems  satisfactory.  If  such 
an  explanation  as  this  is  not  valid,  how  are  we 
to  explain  the  frequent  occurrence  of  early 
tubal  ruptures  and  hematoceles  in  this  class  of 
cases?  It  is  not  possible  by  statistics  to  prove 
the  extent  of  the  etiologic  influence  of  gonor- 
rhea in  ectopic  pregnancy,  but  clinical  obser- 
vation will  show  how  justly  we  may  suspect 
the  preliminary  work  of  the  gonoccoccus  in  this 
sphere  of  action. 

Case  XXIII. — This  patient  was  a  young  mar- 


THE   HOSPITAL   BULLETIN 


67 


ried  woman  admitted  to  the  University  Hospital 
with  procidentia  uteri.  She  gave  no  history  of 
pregnancy.  Upon  examination  the  cervix  was 
found  external  to  the  vulva,  and  both  external 
os  and  fourchette  gave  no  evidence  of  a  pre- 
vious pregnancy.  To  the  left  of  the  uterus  a 
tumor  the  size  of  a  base  ball  could  be  made  out. 
It  presented  the  physical  signs  of  a  small  ovarian 
cyst.  When  the  uterus  was  pushed  up  in  the 
pelvis  the  tumor  was  movable  with  it.  The  diag- 
nosis of  ectopic  pregnancy  was  not  made  until 
the  abdomen  was  opened  and  the  tumor  re- 
moved. Upon  examination  the  specimen  was 
found  to  be  a  distended  tube  contain- 
ing placental  debris  and  coagulated  blood. 
Tubal  rupture  had  not  taken  place,  as  gestation 
had  been  arrested  at  a  very  early  stage  of  de- 
velopment and  the  contents  of  the  tube  had  not 
exercised  sufficient  pressure  to  break  through 
its  distended  walls. 

This  was  clearly  a  case  of  arrested  gestation 
without  expulsion  of  the  embryo,  and  well  ex- 
plains how  the  death  of  the  embryo  may  occur 
without  serious  danger  to  the  patient.  A  fall, 
blow  or  misstep  would  have  been  sufficient  in 
this  case  to  cause  a  rupture  of  the  tube  without 
subjecting  the  patient  to  any  graver  condition 
than  a  small  hematocele.  May  not  many  of  the 
pelvic  hematoceles  be  accounted  for  in  this 
way?  It  is  only  by  a  study  of  the  pathology-  of 
the  tube  found  after  operation  that  we  are  able 
to  arrive  at  a  correct  understanding  of  the  con- 
ditions presented.  The  early  death  of  the  fetus 
in  ectopic  pregnancy  is  the  most  fortunate  dis- 
position which  nature  can  make  to  correct  a 
false  step  in  gestation. 

In  the  case  under  consideration,  the  patient 
had  not  skipped  her  menstruation  and  had 
neither  morning  sickness  nor  enlargement  of 
the  breasts.  But  for  the  pathologic  finding 
pregnancy  would  not  have  been  discovered. 

Case  XXIV. — Mrs.  A.,  age  39  years,  the 
mother  of  one  child,  nine  years  of  age,  was  ad- 
mitted to  the  University  Hospital  in  April, 
J905,  with  a  history  of  ectopic  pregnancy.  Upon 
examination  the  entire  pelvis  was  found  filled 
with  a  doughy  mass,  which  wras  recognized  as 
an  extensive  hematocele  from  a  tubal  rupture 
of  some  days'  standing.  The  blood  as  it  leaked 
from  the  ruptured  tube  had  dissected  its  way 
through  channels  made  in  the  loose  connective 
tissues  of  the  pelvis,  and  had  formed  a  dense 
coagulum,  which  enveloped  the  uterus,  tubes 


and  ovaries  with  one  large  mass  of  blood  and 
fibrin.  In  removing  the  mass  I  found  it  neces- 
sary to  remove  both  tubes  and  ovaries,  and  to 
do  a  supravaginal  hysterectomy.  After  clean- 
ing out  the  pelvis  and  abdomen  I  found  so 
many  small  lymph  deposits  and  uncovered 
spaces  on  the  bladder,  rectum  and  small  intes- 
tines that  I  was  apprehensive  that  a  post-opera- 
tive infection  would  give  trouble.  A  puncture 
was  made  in  Douglas'  cul-de-sac  into  the  vagi- 
na and  a  gauze  drain  was  established  through 
this  route  to  provide  for  the  escape  of  material 
the  peritoneum  might  not  be  able  to  take  care 
of.  The  abdomen  was  closed.  During  conval- 
escence drainage  was  very  considerable,  and  no 
doubt  contributed  to  the  early  convalescence  of 
the  patient. 

The  question  of  vaginal  drainage  in  this  class 
of  cases  is  very  important,  and  whilst  it  may 
not  always  mean  the  difference  between  life 
and  death,  it  may  materially-  influence  conval- 
escence and  post-operative  symptoms.  When 
there  is  an  assurance  that  the  peritoneum  can 
deal  with  leakage  and  debris  unavoidably  left 
after  an  extensive  intrapelvic  operation,  drain- 
age by  either  route  is  unnecessary,  but  when 
this  assurance  is  involved  in  grave  doubt  it  will 
depend  upon  the  judgment  of  the  .  operator 
whether  he  shall  drain  primarily  or  wait  for 
positive  indications  during  the  post-operative 
period.  Men  of  experience  will  always  differ 
in  answering  this  question.  The  only  answer 
one  can  give  is  based  upon  one's  instincts. 
There  is  a  monitor  which  seems  to  suggest  a 
proper  line  of  action  in  the  majority  of  in- 
stances and  the  man  who  exercises  judgment  is 
less  likely  to  fail  than  one  who  is  biased  in  favor 
of  or  against  a  given  procedure.  The  indica- 
tions for  abdominal  drainage  should  be  so  pro- 
nounced that  it  is  accepted  or  rejected  at  once. 
Vaginal  drainage,  on  the  contrary,  imposes  no 
severe  discomfort  upon  the  patient,  and  the 
opening  may-  be  closed  in  a  few  days  without 
difficulty.  It  provides  for  a  concealed  leakage 
and  keeps  the  operator  in  closer  touch  with  in- 
trapelvic conditions. 

The  drain-canal  should  be  accommodated  to 
the  condition  calling  for  its  use. 

In  large  areas  of  leaky  surfaces  considerable 
packing  should  be  done.  In  other  cases  a  lamp- 
wick-drain  may  be  sufficiently  large  to  control 
the  conditions  left  within  the  pelvis  and  to  pro- 
vide an  outflow  that  would  occasion  trouble  if 


68 


THE   HOSPITAL   BULLETIN 


left  to  seek  its  own  outlet.  Convalescence  may 
be  hastened  by  a  properly  used  vaginal  drain 
or  retarded  by  trusting  too  much  to  nature's 
methods  of  removing  exudates. 

Case  XXVII. — Mrs.  M.,  multipara,  youngest 
child  15  years  of  age,  had  married  her  second 
husband  four  years  ago.  She  had  missed  two 
menstrual  periods.  She  had  all  the  usual  signs 
of  pregnancy.  For  several  days  she  had  suf- 
fered with  colicky  pains  in  her  pelvis,  but  at- 
tached no  importance  to  them.  At  3  P.  M.  of 
November  7,  1905,  she  was  seized  with  violent 
pains,  followed  by  shock  and  collapse.  Dr.  La 
Bara,  her  physician,  was  hastily  called  in,  and 
upon  examination  diagnosed  a  ruptured  tubal 
pregnancy  with  concealed  hemorrhage.  He  had 
the  patient  conveyed  to  the  University  Hos- 
pital as  soon  as  the  ambulance  could  be  ob- 
tained. She  reached  the  hospital  between  5 
and  6  o'clock  in  a  profoundly  collapsed  condi- 
tion, with  a  pulse  weak,  thready  and  over  150 
per  minute,  respiration  quick  and  shallow  and 
hemoglobin  under  50  per  cent.  It  was  neces- 
sarv  to  give  normal  salt  injections  and  strych- 
nin to  keep  up  the  flagging  circulation.  I 
reached  the  hospital  at  7  o'clock  and  an  abdom- 
inal section  was  imperative  at  once.  The 
blanched  and  collapsed  condition  of  the  patient 
gave  little  encouragement.  Upon  opening  the 
abdomen  over  one  quart  of  fresh  arterial  blood 
was  found  in  the  pelvis  and  among  the  intes- 
tines. The  tubes  were  hurriedly  sought  for 
and  the  left  tube  was  found  ruptured  from  over- 
distension on  its  upper  border  and  still  leaking 
at  the  site  of  rupture.  It  was  tied  off  promptly 
and  hemorrhage  at  once  ceased.  The  intra-ab- 
dominal cavity  was  thoroughly  cleansed  and 
then  filled  with  normal  salt  solution.  No  fetus 
was  found.  The  patient  rallied  slowly  from  the 
operation,  and  within  four  weeks'  time  had  re- 
gained her  loss  of  blood.  But  for  the  prompt 
abdominal  section  this  patient  would  have  per- 
ished in  a  few  hours. 

Of  the  following  series  of  cases,  Nos.  XXVII., 
XLIIL,  XLIV.  and  XLY.  are  the  only  ones 
that  present  unusual  clinical  features.  In  the 
cases  reported  I  have  given  brief  descriptions 
of  unusual  symptoms  and  conditions  which 
serve  to  illustrate  the  treacherous  behavior  of 
tubal  gestation. 

It  will  be  observed  that  the  question  of  diag- 
nosis is  the  all-important  question  in  dealing 
with  the  condition.    It  will  also  be  noticed  how 


seldom  the  diagnosis  is  made  before  the  patient 
reaches  the  operating  table.  I  have  found  that 
over  70  per  cent,  of  the  cases  operated  upon 
were  simple  pathological  finds.  The  history  of 
the  case  and  symptoms  presented  no  positive 
evidence  of  the  condition  while  the  physical 
examination  only  revealed  intrapelvic  masses 
of  tubal  or  ovarian  origin,  showing  some  path- 
ological condition  of  these  organs  necessitating 
an  intra-abdominal  operation. 

Case  XLIII.  — ■  This  patient's  history  is 
worthy  of  record,  since  it  illustrates  the  ex- 
treme degree  of  involvement  of  the  intra-pelvic 
space  with  the  debris  of  an  extopic  rupture. 
The  patient,  35  years  of  age,  was  admitted  to 
the  hospital  from  Virginia.  She  was  greatly  re- 
duced in  flesh  and  was  critically  ill.  Physical 
signs  showed  a  large  mass  in  the  pelvis  extend- 
ing well  above  pubic  region.  Diagnosis  of  rup- 
tured pregnancy  suspected.  History  of  arrested 
gestation  of  some  weeks'  standing  was  the  only 
cue  to  her  condition. 

She  was  so  weak  and  emaciated  when  put  on 
the  operating  table  that  strychnia  and  normal 
salt  infusions  were  given  before  she  was  anaes- 
thetized. 

The  operation  proved  to  be  a  very  extensive 
one.  It  became  necessary  to  remove  not  only 
large  masses  of  clotted  blood,  with  both  tubes 
and  ovaries,  but  also  to  remove  the  uterus.  The 
disorganization  of  the  pelvic  connective  tissue 
and  ragged  condition  of  the  surrounding  struc- 
tures made  it  necessary  to  drain  by  both  vagi- 
nal and  abdominal  routes.  The  patient  was  so 
profoundly  shocked  by  the  operation  that  her 
death  on  the  table  was  fully  expected.  When 
placed  in  bed  restoratives  were  used  constantly 
until,  after  some  36  hours,  she  began  to  revive. 
As  drainage  was  free,  her  convalescence  was 
slow  and  tedious,  but  her  recovery  was  com- 
plete. 

Case  XLIV. — This  case  presents  several  unu- 
sual symptoms.  Mrs.  A.,  age  39,  mother  of  one 
child,  16  years  of  age,  during  a  recent  visit  to 
Europe  began  to  experience  unusual  pelvic  dis- 
comfort. There  were  no  positive  signs  of  preg- 
nancy, but  a  slight  interruption  of  menstruation 
for  several  weeks,  followed  by  a  continuous  dis- 
charge of  blood  from  the  uterus,  lead  to  a  sus- 
picion of  a  possible  early  abortion.  During  her 
trip  across  the  ocean  and  for  several  weeks 
after  her  return  home  uterine  hemorrhage  con- 
tinued more  or  less  freely.     Upon  examination 


THE   HOSPITAL   BULLETIN 


69 


a  distinct  intrapelvic  tumor  to  the  left  of  the 
uterus,  and  closely  attached  to  it,  was  easily 
made  out.  The  hardness  of  the  tumor  and  its 
close  attachment  to  the  uterus  gave  the  impres- 
sion that  it  was  a  fibroid.  An  operation  was 
advised,  and  some  two  weeks  later  was  per- 
formed. The  tumor  proved  to  be  an  enlarged 
tube  containing  placental  debris.  The  foetus 
had  perished  early  and  had  been  absorbed.  The 
uterine  hemorrhage  was  found  to  be  due  to  the 
overflow  of  blood  from  the  tube,  which  was 
leaking  through  the  intra-uterine  orifice.  This 
leakage  of  blood  had  occasioned  the  menor- 
rhagia,  and  had  also  prevented  a  rupture  of  the 
tube  from  overdistension.  It  fortunately  pre- 
vented an  intrapelvic  hematocele,  so  often  met 
with  in  these  cases.  At  the  time  of  the  opera- 
tion a  slight  leakage  of  blood  had  found  its  way 
into  the  pelvic  cavity.  This  patient  made  an 
early  recovery. 

Case  XLV. — This,  the  last  case  of  this  series, 
was  operated  on  on  May  7  last.  In  some  respects 
it  is  one  of  the  most  instructive  of  this  series.  The 
patient  was  married,  19  years  ago,  and  had 
borne  no  children.  She  was  admitted  to  the  hos- 
pital on  May  the  6th  in  a  very  critical  condition. 
There  was  no  history  of  pregnancy  and  the  physi- 
cal signs  pointed  to  an  inflammatory  mass  filling 
the  pelvis,  an  acute  bilateral  salpingitis.  The 
patient  was  running  a  high  temperature  with  a 
weak  and  rapid  pulse.  She  was  so  depressed  that 
it  was  deemed  best  not  to  operate  until  the  fol- 
lowing morning.  Ice  caps  were  placed  over  the 
lower  abdomen  and  strychnia  and  morphia 
were  given  in  full  doses. 

When  placed  on  the  operating  table  her  condi- 
tion was  extremely  critical.  Stimulants  and  infu- 
sion of  normal  salt  were  given  during  anaesthesia. 
Physical  examination  under  ether  did  not  clear 
up  the  doubt  as  to  the  character  of  the  intra- 
pelvic mass.  When  the  abdomen  was  opened 
the  condition  was  manifest.  The  abdominal 
cavity  was  filled  with  masses  of  dark-colored 
clotted  blood.  The  tube  in  the  left  side  had 
ruptured  from  an  early  pregnancy,  whilst  the 
right  tube  was  partially  disorganized  from  an 
old  salpingitis.  I  have  never  met  as  much  free 
flow  of  blood  in  an  abdominal  cavity.  It  was  ap- 
parently of  some  days'  standing,  as  no  leaking 
vessels  were  found.  Before  the  operation  was 
half  completed  the  assistant  remarked  to  me  that 
the  patient  was  apparently  dying.  I  replied 
that  I  would  complete  the  operation  whether 


the  patient  was  dead  or  alive,  and  as  rapidly  as 
I  could  finished  the  technique  of  the  operation. 
When  this  was  done  and  the  condition  of  the 
patient  was  investigated,  I  agreed  with  my  as- 
sistant that  the  patient's  chances  for  living 
were  poor  indeed.  Thanks  to  the  patient  and 
intelligent  work  of  my  assistants,  Drs.  Brent, 
Hammond  and  Mackall,  the  patient  began  to 
rally,  and  within  24  hours  had  fully  recovered 
from  shock.  She  then  made  a  very  rapid  re- 
covery. 

I  wish  here  to  offer  a  few  suggestions  which 
may  be  helpful  to  younger  surgeons.  I  have  a 
number  of  times  been  told  by  the  assistant  that 
the  patient  was  dead  or  dying  on  the  table,  to 
hurry  up  the  operation  or  to  sew  up  the  inci- 
sion before  the  operation  was  completed.  Ex- 
perience has  shown  me  that  it  is  better  judg- 
ment to  do  a  complete  operation  on  a  compar- 
atively dying  patient  than  to  hurry  to  close  the 
incision  and  leave  behind  conditions  which  will 
surely  cause  the  death  of  the  patient  a  few 
hours  or  few  days  later.  I  know  I  have  saved 
a  number  of  patients  who  were  apparently  dy- 
ing on  the  table  by  following  this  rule. 

It  must  be  borne  in  mind  that  apparent  shock 
is  often  due  to  profound  anaesthesia.  A  broken 
down  heart  will  often  recover  when  the  anaes- 
thetic is  withdrawn  and  powerful  stimulation 
is  used.  This  little  line  is  worth  remembering 
in  surgery,  as  well  as  in  its  application  to  the 
many  discouragements  of  life : 
"Never  give  up;  there  are  chances  and  changes 

Helping  the  hopeful  a  hundred  to' one; 
And  through  the  chaos  high  heaven  arranges 

Ever  success  if  you  only  hope  on." 

Conclusions. — Ectopic  pregnancy  is  a  much 
more  common  cause  of  intrapelvic  disease  than 
lias  been  supposed. 

Rupture  of  the  tube  from  overdistension  is 
the  chief  cause  of  intrapelvic  hematocele.  Pri- 
mary rupture  into  the  folds  of  the  broad  liga- 
ment occurs  far  more  frequently  than  any 
other  form  of  rupture,  and  is  attended  with  less 
danger  to  the  patient. 

Tubal  abortions  are  infrequent,  but  the  death 
of  the  fetus  at  a  very  early  stage  of  develop- 
ment may  result  in  a  hematoma  of  the  tube  or 
give  rise  to  a  hemato-salpinx,  requiring  a  re- 
moval of  the  damaged  tube. 

Gonorrheal  salpingitis  is  the  most  frequent 
cause  of  tubal  gestation,  and  of  early  death  of 
the  embryo. 


70 


THE   HOSPITAL  BULLETIN 


Tubal  pregnancy  is  the  common  form  of  ec- 
topic gestation  and  the  primary  stage  of  the 
abdominal  variety. 

The  tubo-ovarian  variety  was  found  in  one 
case  of  this  series  of  45  cases. 

Ectopic  pregnancy  is  a  treacherous  condition 
and  should  be  arrested  by  an  abdominal  section 
as  soon  as  it  is  recognized. 


PRESIDENT'S  ADDRESS  AT  THE  .MEET- 
ING OF  THE  MEDICAL  ALUMNI 
ASSOCIATION. 
By  Thomas  M.  Chaney,  M.  D.,  Chaney,  Md. 

To  the  Alumni  Association  of  the  School  of  Med- 
icine of  the  University  of  Maryland: 
I  thank  you,  gentlemen,  for  the  honor  you  con- 
ferred upon  me  a  year  ago  in  making  me  Presi- 
dent of  this  Association. 

Every  alumnus  of  the  Medical  School  of  the 
University  should  be  proud  of  his  relation  to  it. 
Back  of  him  are  one  hundred  years  of  useful 
work  by  the  alumni  of  this  school,  throughout 
the  world  and  especially  in  this  State. 

In  my  opinion  this  school  has  been  the  most 
useful  educational  institution  that  has  ever  ex- 
isted in  this  State.  It  has  done  more  than  any 
other  for  the  health,  the  comfort  and  well-being 
of  the  people  of  this  State  by  sending  out  men 
equipped  to  give  relief  to  the  sick,  men  in  ad- 
vance of  others  in  their  communities  in  intelli- 
gence and  morality,  and  men  who  by  association 
with  professors  who  had  high  ideals  of  their  pro- 
fessional duties  had  gotten  the  best  preparation 
possible  for  becoming  useful  and  upright  citizens. 
There  are  no  educational  institutions  in  the  State 
and  few  in  the  country  that  hold  such  a  record 
as  does  this  school.  There  are  older  schools  in 
the  State,  but  ours  is  the  oldest  medical  school, 
and  I  claim  that  the  services  of  a  well  prepared, 
conscientious  physician  are  more  important  in  a 
community  than  those  of  the  best  men  belonging 
to  any  other  profession. 

For  many  years  being  the  only  medical  school 
in  the  State,  it  supplied  with  physicians  every 
part  of  this  State  and  much  of  Virginia,  the  Car- 
olinas  and  other  Southern  States.  This  is  our 
record. 

Many  who  attended  our  school  years  ago  look 
back,  and.  recalling  such  names  as  McSherry, 
Aiken.  Miltenberger,  Smith,  Chew  and  others, 
speak  of  that  as  the  golden  period  of  our  school. 
A  few  years  ago,  while  living  in  the  city,  I  had 
good  opportunities   for  seeing  the   work  in  the 


different  medical  schools  and  hospitals  of  the 
city.  I  became  convinced  that  this  school  is 
doing  better  work  now  than  it  has  ever  done  at 
any  period  since  I  have  been  familiar  with  it,  and 
that  it  is  doing  as  good  work  as  any  other  school 
in  the  city.  As  proof  of  this  faith  I  offer  my 
works.  Two  Chaney  boys,  a  son  and  a  nephew, 
have  recently  been  added  to  the  list  of  alumni  of 
the  school,  and  nearly  or  quite  all  persons  who 
come  from  our  part  of  the  country  to  enter  a 
hospital  come  to  the  University  Hospital.  In  our 
part  of  the  State — Calvert  and  lower  Anne  Arun- 
del— physicians  who  graduated  at  other  schools 
send  their  patients  here.  This  is  the  best  proof 
of  the  estimate  placed  upon  the  work  of  the  men 
now  in  charge  of  the  school  and  the  hospital. 

The  future  of  the  school  is  assured.  There  is 
no  reason  for  alarm.  We  send  no  Jack  Binns 
to  send  out  C.  O.  D.  messages.  But  the  compe- 
tition between  the  medical  schools  of  the  city  is 
greater  than  ever  before.  Here  and  throughout 
the  country  schools  of  all  kinds  are  making 
changes  with  a  view  to  improving  their  courses 
of  study  and  giving  better  training  to  their 
pupils. 

The  formation  of  an  advisory  council  is  one 
that  has  already  been  started  in  connection  with 
the  University  of  Maryland.  Another  change 
from  Provost  to  President.  University  of  Vir- 
ginia, Win.  Wirt,  first  elected  to  Presidency ; 
then  Dr.  Alderman.  But  these  subjects  will  be 
discussed  by  others.  The  one  important  ques- 
tion for  us  tonight  is  disbandment.  However 
this  may  be,  let  us  keep  up  our  interest  and  re- 
turn year  by  year,  and  as  Antaeus  become  in- 
vincible by  touching  his  mother  earth. 


REPORT  OF  COM MITTEESTOREGENTS 
OF  UNIVERSITY  OF  MARYLAND  (  >N 
REORGANIZATION    OF    UNIVERSITY 
MANAGEMENT,  Etc. 
To  the  Regents: 

At  our  last  meeting  two  committees  were 
appointed,  consisting  of  Professors  Hemmeter, 
Poe  and  Ashby,  and  Professors  Poe,  Harlan 
and  Coale,  to  consider  a  preamble  and  resolu- 
tion adopted  by  the  General  Alumni  Associa- 
tion of  the  University,  suggesting  the  election 
of  a  paid  provost  or  president,  with  a  govern- 
ing body  independent  of  the  teaching  bodies, 
and  to  confer  with  the  General  Alumni  Asso- 
ciation as  to  the  expediency  of  the  establish- 
ment of  an  advisory  council  from  amongst  the 


THE   HOSPITAL   BULLETIN 


71 


alumni  to  communicate  with  the  Regents  on 
problems  of  university  administration. 

Inasmuch  as  these  two  resolutions,  while  not 
identical,  related  to  the  same  matter,  the  mem- 
bers of  these  two  committees  deemed  it  ex- 
pedient to  consider  them  jointly,  with  a  view 
to  the  better  understanding  of  the  questions  re- 
ferred to  them. 

Having  been  formally  advised  of  the  appoint- 
ment of  a  special  committee  of  ten  of  the  Gen- 
eral Alumni  Association,  with  instructions  to 
present  to  the  Regents  a  recommendation  from 
the  General  Alumni  Association  looking  to 
alumni  representation  in  the  Board  of  Regents, 
your  committee  invited  this  committee  of  ten 
to  a  conference,  which  was  held  at  the  office  of 
Professor  Poe  on  the  5th  of  May,  instant. 

At  this  conference  the  views  of  the  commit- 
tee of  the  General  Alumni  Association  were 
presented  and  discussed;  the  text  of  the  rec- 
ommendation of  the  General  Alumni  Associa- 
tion was  laid  before  your  committees,  and  a 
full  statement  made  of  the  views  and  wishes 
of  the  Alumni  Association  upon  the  whole  sub- 
ject. 

Your  committees  have  considered  with  some 
care  the  matters  submitted  to  them,  and  the 
arguments  of  the  Special  Committee  of  Ten, 
and  now  present  the  conclusions  which  they 
have  reached. 

Upon  an  examination  of  the  charter  of  the 
University,  as  contained  in  the  Act  of  181 2, 
Chapter  159.  your  committees  do  not  find  any 
provision  under  which  the  recommendation  of 
the  General  Alumni  Association  for  the  elec- 
tion from  the  alumni  of  five  members  to  the 
Board  of  Regents  could  be  validly  accom- 
plished. 

Regents  are  authorized,  and  the  mode  of 
their  appointment  prescribed,  for  the  several 
faculties  which,  by  the  charter,  constitute  the 
University,  but  we  find  no  warrant  for  the  in- 
troduction into  the  body  of  Regents  of  mem- 
bers not  representing  or  professing  to  repre- 
sent any  one  of  these  several  faculties. 

When  it  is  borne  in  mind  that  of  the  present 
Board  of  twenty-three  Regents  fifteen  are 
alumni,  who,  in  their  position  as  regents  and  as 
alumni,  are  thoroughlv  in  touch  with  the 
alumni,  and  may  well  be  understood  to  repre- 
sent their  views  and  wishes,  it  is  not  easy  to 
see  how  the  introduction  into  the  Board  of  Re- 
gents of  five  new  members  selected  from  the 


great  body  of  alumni,  not  engaged  at  all  in  the 
work  of  the  University,  can  add  to  the  vigor 
and  efficiency  of  her  work ;  and  your  commit- 
tee, therefore,  find  no  reason  to  regret  that  the 
provisions  of  the  charter  are  not  sufficiently 
elastic  to  lead  us  to  accept  the  recommendation 
in  this  particular  of  the  General  Alumni  Asso- 
ciation ;  and  more  especially  is  this  the  case 
when  it  is  further  borne  in  mind  that  the  policy 
of  the  several  faculties  is  to  fill  vacancies  in 
their  number,  as  they  occur,  from  amongst  the 
best-equipped  of  our  alumni. 

While,  therefore,  we  cannot  recommend  ac- 
ceptance of  this  recommendation,  we  see  no 
reasonable  ground  of  objection  to  the  plan  re- 
cently adopted  by  the  Johns  Hopkins  Univer- 
sity looking  to  the  selection  of  an  advisory 
council  of  ten  or  fifteen  from  amongst  the 
alumni,  with  whom,  under  suitable  rules  and 
regulations  to  be  formulated  by  the  Regents, 
consultations  can  be  had  relating  to  problems  of 
Universitv  administration  and  education,  and 
we  are  free  to  say  that  we  would  welcome  the 
appointment  of  such  an  advisory  council,  and 
do  not  doubt  that  valuable  assistance  would  be 
given  to  the  general  work  of  the  University  by 
suggestions  and  advice  from  time  to  time  from 
such  representatives  of  the  alumni. 

Your  committee  have  also  considered  the 
subject  covered  by  the  preamble  and  resolution 
of  the  Alumni  Association  looking  to  the  elec- 
tion of  a  paid  provost  or  president. 

The  charter  does  not  contemplate  the  per- 
formance by  the  provost  of  active  administra- 
tive duties  calling  for  constant  attention  or  su- 
pervision, and  entitling  the  incumbent  of  the 
office  to  compensation,  but  there  is  no  prohibi- 
tion against  an  enlargement  of  the  duties  which 
he  is  now  performing,  nor  is  there  anything  in 
the  charter  to  prevent  the  Regents  from  affix- 
ing to  the  office  of  Provost  a  salary  commensu- 
rate with  the  dignity  of  the  position  and  the 
duties  which,  under  proper  rules  and  regula- 
tions, the  Board  of  Regents  are  authorized  to 
assign  to  him. 

The  practical  difficulty  in  the  way  of  fixing 
a  large  salary  to  his  official  position  is  that  the 
University  has  no  endowment  out  of  which 
such  compensation  could  come,  and  accord- 
ingly the  only  source  from  which  such  com- 
pensation could  be  derived  would  be  an  assess- 
ment made  by  the  Regents  upon  the  shares  of 
the   tuition   fees   respectively   received   by  the 


72 


THE   HOSPITAL   BULLETIN 


various  members  of  our  several  faculties  of  in- 
struction. 

This,  of  course,  would  involve  an  annual  re- 
duction of  the  amount  received  by  each  profes- 
sor, but  we  are  sure  that  a  moderate  contribu- 
tion will  be  cheerfully  agreed  to  by  all  the 
members  of  our  teaching  faculties  in  order  to 
secure  a  closer  supervision  of  the  details  of  our 
university  work  by  our  presiding  officer  than 
has  ever  been  expected  from  him  or  his  distin- 
guished predecessor,  if  such  additional  supervi- 
sion shall  be  deemed  necessary  for  the  progress 
of  the  University. 

In  answer  to  the  suggestion  of  the  General 
Alumni  Association  upon  the  subject,  we  rec- 
ommend that  it  be  at  once  taken  into  consid- 
eration by  a  special  committee,  to  be  appointed 
for  the  purpose,  consisting  of  one  representa- 
tive from  each  of  our  five  faculties,  to  report  at 
our  next  regular  meeting. 

In  connection  with  this  question  of  the  elec- 
tion of  a  paid  provost,  your  committees  have 
also  considered  the  additional  vague  and  indefi- 
nite recommendations  of  representatives  of  the 
alumni  for  a  reorganization  of  the  University 
by  the  creation  of  "a  governing  body  of  trus- 
tees independent  of  the  teaching  bodies." 

The  charter  does  not  contemplate  or  warrant 
such  a  method  of  carrying  on  the  work  of  the 
University,  and  so  radical  a  change  in  our  or- 
ganization does  not  commend  itself  to  our 
judgment. 

It  could  not  be  made  without  a  substantially 
new  charter,  and  if  this  were  obtained  we  do 
not  perceive  how  the  work  which  the  Univer- 
sity is  now  doing  with  such  gratifying  effi- 
ciency and  success  could  be  enlarged  and  im- 
proved under  the  direction  of  a  board  of  trus- 
tees, none  of  whom  would  be  members  of  our 
several  teaching  bodies. 

To  start  with,  there  would  be  great  difficulty 
in  obtaining  the  services  of  public-spirited  and 
properly  qualified  men  who,  without  compen- 
sation, would  give  the  necessary  time  and  at- 
tention to  the  heavy  and  responsible  labor  of 
directing  the  administration  of  our  several  de- 
partments; nor  can  it  be  reasonably  expected 
that  our  present  force  of  professors  would  vol- 
untarily relinquish  their  positions  and  turn 
over  to  an  entirely  new  Board  of  Trustees  com- 
plete control  of  the  affairs,  property,  resources 
and  revenues  of  the  University. 

Moreover,  there  is  the  initial  and  apparently 
insuperable  difficulty  in  determining  how  and 
by  whom  this  new  Board  of  Trustees  are  to  be 
selected. 

The  small  number  of  alumni  from  whom 
conies  this  request  for  the  destruction  of  our 
existing  organization  do  not  suggest  any  way 
of  solving  this  difficulty. 


If,  however,  these  practical  obstacles  could 
be  surmounted;  if  our  present  Board  of  Re- 
gents were  to  step  down  and  out;  if  we  had  a 
new  Board  of  Trustees  clothed  with  full  au- 
thority to  administer  the  work  of  the  Univer- 
sity in  its  several  departments,  with  a  paid 
Provost  or  President  receiving  a  fairly  large 
salary  out  of  a  fund  yet  to  be  raised  in  the  dis- 
tant future,  what  reason  is  there  to  believe  that 
we  would  have  an  increase  in  the  number  and 
quality  of  our  students,  or  more  efficient, 
thorough   and  successful  teaching? 

In  short,  what  better  results  can  be  looked 
for  from  a  new  governing  body  and  a  new  fac- 
ulty of  instruction  for  each  of  our  several  de- 
partments than  we  have  now? 

Viewing  this  subject  in  every  respect,  we  fail 
to  see  the  benefits  that  would  accrue  to  the 
University  by  annulling  our  present  charter 
and  taking  a  leap  in  the  dark. 

As  embodying  our  conclusions  we  submit 
the  following  resolutions : 

Resolved,  That  the  Secretary  be,  and  he  is  here- 
by, instructed  to  report  to  the  Committee  of 
Ten  of  the  General  Alumni  Association  that 
the  Regents  have  carefully  considered  their 
recent  communication  proposing  the  election 
by  the  alumni  of  five  representatives  of  the 
alumni,  none  of  whom  shall  be  full  professors, 
as  additional  members  of  the  Board  of  Regents, 
and  that,  upon  an  examination  of  the  charter, 
the  Regents  find  no  warrant  for  such  an  addi- 
tion to  their  members;  nor  are  the  Regents  in- 
clined to  recommend  to  the  General  Assembly 
an  amendment  to  the  charter  authorizing  this 
proposed  change  in  the  organization  of  the 
Board  of  Regents. 

Resolved,  further,  That  the  Regents  approve 
the  election  by  the  alumni  of  an  Advisory 
Council,  empowered  to  present  from  time  to 
time  to  the  Regents  their  views  and  wishes, 
and  assure  the  Association  of  Alumni  that  the 
Regents  will  gladly  welcome  and  always  care- 
fully consider  suggestions  and  recommenda- 
tions emanating  from  such  Advisory  Council. 

Resolved,  also,  That  the  Secretary  report  fur- 
ther to  the  Alumni  Association  that  their  sug- 
gestion with  reference  to  the  payment  of  a  sal- 
ary to  our  Provost  is  now  under  consideration 
by  the  Regents,  and  shall  be  acted  upon  at  an 
early  date ;  and  further,  that  the  Regents  see 
no  reason  for  a  reorganization  of  the  Univer- 
sity by  "the  creation  of  a  governing  body  of 
trustees  independent  of  the  teaching  bodies," 
and  are,  consequently,  opposed  to  an  amend- 
ment of  the  charter  of  the  University  in  order 
to  accomplish  this  suggested  reorganization. 
John  Prentiss  Poe, 
Henry  D.  Harlan, 

R.    DORSEY   COALE, 

Thomas  A.  Ashby, 
John  C.  Hem  meter, 
May  26,  1909.  Committee. 


THE   HOSPITAL  BULLETIN 


73 


THE  HOSPITAL   BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

EDITED    BY 

A    COMMITTEE    OF   THE    HOSPITAL   STAFF 


PUBLISHED    BY    THE 

HOSPITAL   BULLETIN   COMPANY 
University  of  Maryland 


Business  Address, Baltimore,  Md. 

Editorial  Address University  of  Maryland 

Baltimore,  Md.,  June  15,  1909 

EDITORIAL. 
The  Recent  Commencement  at  the  Uni- 
versity of  Maryland. — On  May  31st,  in  the 
Academy  of  Music,  the  annual  commencement 
of  all  of  the  Departments  of  the  University  of 
Maryland  was  held  in  the  presence  of  a  large  and 
brilliant  audience.  The  occasion  was  a  most  im- 
pressive one  and  the  exercises  were  most  inspir- 
ing. Degrees  were  conferred  upon  zyj  students, 
the  Medical  Department  leading  with  89  grad- 
uates. 

The  Bulletin  takes  pleasure  in  referring  to 
the  work  of  all  the  Departments  of  the  Univer- 
sity which  gives  evidence  of  growth  and  im- 
provement during  the  past  year.  The  joint  com- 
mencement of  the  Departments,  the  splendid 
classes  of  young  graduates  and  the  combined  in- 
terests of  the  Faculties  in  the  educational  work 
of  the  University,  all  show  the  continued  growth 
of  the  University  spirit  and  the  progress  which 
the  University  is  making  in  the  educational  world. 
The  man  who  fails  to  see  the  substantial  gains 
which  each  Department  of  the  University  is  mak- 
ing from  year  to  year  is  a  pessimist  of  deepest 
prejudice.  The  true  friends  of  the  University, 
who  see  facts  in  their  proper  light,  must  realize 
that  this  continued  cry  for  radical  changes  in 
University  management,  for  sudden  upheavals 
of  traditions  and  policies  in  its  government,  are 
not  fully  warranted  at  the  present  time. 

Every  thinking  mind  knows  full  well  that  all 
methods  may  be  improved  under  proper  condi- 
tions. The  work  now  carried  on  by  each  De- 
partment could  be  materially  improved  were  con- 
ditions more  favorable  for  radical  reforms  in 
policies  and  methods  of  government.  With 
plenty  of  money  and  practical  leadership  it  might 
be  possible  to  bring  about  the  changes  which 
some  of  the  optimistic  friends  of  the  University 


have  so  earnestly  advocated.  At  the  present  time 
the  University  has  neither  plenty  of  money  nor 
can  she  command  that  practical  leadership  which 
is  so  necessary  to  guarantee  success  in  a  depar- 
ture so  radical  as  has  been  proposed. 

In  the  present  Board  of  Regents  the  alumni  of 
the  University  are  liberally  represented.  We  can- 
not believe  that  a  Board  of  Trustees  composed 
of  men  who  are  not  connected  with  the  different 
Faculties  could,  without  a  large  endowment,  con- 
duct the  work  of  the  University  to  better  advan- 
tage to  the  University  than  the  present  Board  of 
Regents,  now  so  largely  interested  in  the  work  of 
the  different  Departments.  It  would  be  well  for 
those  who  are  so  active  in  urging  radical  de- 
partures from  present  methods  of  government  to 
think  well  and  wisely.  Are  the  changes  which 
they  propose  practical  or  rational  at  this  time? 
Is  it  not  more  rational  to  assume  that  results  will 
follow  through  gradual  steps  rather  than  by  a 
sudden  leap  into  the  dark,  which  would  most 
probably  plunge  the  University  into  a  whirlpool 
of  disaster? 

In  the  world  of  education  as  in  the  world  of 
commerce  and  trade,  revolutions  are  most  usually 
disastrous.  The  law  of  progress  is  grounded  on 
established  principles.  Results  only  follow  ra- 
tional and  definite  lines  of  action.  The  future 
growth  of  a  greater  University  of  Maryland 
must  come  through  gradual  steps,  through  prac- 
tical and  conservative  lines  of  policy,  not  by  up- 
rooting the  great  system  of  a  century's  growth  by 
violence  and  planting  a  lot  of  saplings  which  may 
never  flourish.  The  men  who  now  govern  the 
affairs  of  the  University  are  as  jealous  of  her  in- 
terests and  are  as  anxious  to  enlarge  her  sphere 
of  influence  and  usefulness  as  any  of  her  alumni. 
They  will  not  be  diverted  from  their  sense  of  duty 
to  the  University  by  spurious  arguments  or 
fanciful  reasonings.  As  facts  evolve  they  are 
prepared  to  grasp  them,  and  as  conditions  war- 
rant methods  and  policies  will  be  adjusted  to  meet 
them. 

Resignation  of  Prof.  Samuel  C.  Chew. — 
The  alumni  of  the  University  of  Maryland  will 
learn  with  profound  regret  that  Professor  Chew 
has  resigned  the  chair  of  Professor  of  Medicine, 
which  he  has  filled  for  so  many  years  with  rare 
grace,  efficiency  and  distinction.  Professor  Chew 
was  elected  to  the  chair  of  Materia  Medica  and 
Therapeutic  in  1864.  Upon  the  retirement  of 
Prof.    Richard   Mc Sherry   from  the   Faculty  of 


74 


THE   HOSPITAL   BULLETIN 


Physic  in  1885,  Professor  Chew  was  elected  to 
the  chair  of  Principles  and  Practice  of  Medicine, 
which  he  has  held  until  the  present  time  with  the 
recent  change  of  the  title  of  the  chair,  at  Pro- 
fessor Chew's  request,  to  Professor  of  Medi- 
cine. Professor  Chew's  service  in  the  Faculty  of 
Physic  has  exceeded  in  number  of  years  the 
service  of  any  one  who  has  held  a  chair  in  the 
Faculty  of  Physic.  It  is  but  proper  to  say  that 
no  one  who  has  ever  filled  a  chair  in  the  Univer- 
sity has  rendered  a  more  loyal,  valuable  and  pop- 
ular service  to  the  institution  than  has  Professor 
Chew.  His  varied  accomplishments  as  a  teacher, 
his  urbanity,  dignity  and  pure  character,  his 
splendid  influence  over  the  student  body  and  over 
the  alumni,  and  his  exalted  position  in  this  com- 
munity as  a  gentleman  of  the  highest  culture  and 
refinement,  are  distinctions  which  it  is  permitted 
to  few  men  to  reach  in  any  calling  in  life. 

We  say  it  without  hesitation  that  no  man  con- 
nected with  the  Faculty  of  Physic  has  ever  been 
more  beloved  and  esteemed  by  his  associates  in 
the  educational  work  of  the  University  than  has 
been  Professor  Chew.  His  retirement  from  the 
active  work  of  the  chair  he  has  so  long  graced 
has  brought  deep  sorrow  to  his  colleagues.  We 
are  happy  to  know,  however,  that  as  Emeritus 
Professor  of  Medicine  we  shall  retain  his  deep 
and  abiding  interest  in  and  loyalty  to  the  old 
University.  We  wish  many  years  of  health  and 
happiness  to  him  in  his  retirement  and  pray  rev- 
erently that  the  Giver  of  All  Good  will  grant  to 
him  the  satisfaction  and  rewards  which  should 
come  from  a  life's  work  so  given  up  to  the  high- 
est aims  and  ideals  of  service  to  his  fellow-man. 

Commencement  Exercises  and  Degrees 
Conferred. — Degrees  were  conferred  upon  237 
graduates  in  the  arts  and  sciences,  medicine,  law, 
denistry  and  pharmacy  at  the  annual  commence- 
ment of  the  University  of  Maryland  at  the 
Academy  of  Music,  Monday,  May  31,  1909. 
Among  the  graduates  were  three  young  women, 
one  in  dentistry  and  two  in  pharmacy.  Five  hon- 
orary degrees  were  also  conferred. 

Among  those  upon  whom  honorary  degrees 
were  conferred  were  Chief  Judge  Andrew  Hun- 
ter Boyd,  of  the  Court  of  Appeals,  and  Dr.  John 
Allan  Wyeth,  of  New  York,  who  delivered  the 
address  to  the  graduates. 

In  presenting  the  name  of  Chief  Judge  Boyd 
for  the  degree  Mr.  John  P.  Poe,  Dean  of  the 
University,  said  : 

"One   of    the    most    gratifying   facts    in   our 


Maryland  history  is  that  the  chief  justices  of 
our  Court  of  Appeals  have  always  been  men  of 
pre-eminent  professional  distinction.  In  casting 
our  eyes  over  the  list  of  those  who  from  the 
foundation  of  the  court  down  to  the  present  time 
have  presided  over  its  deliberations  the  record 
shows  that  its  chiefs  have  invariably  been 
learned,  laborious,  discriminating,  always  uniting 
attractive  clearness  of  statement  with  convincing 
strength  of  reasoning  in  their  judicial  opinions. 

"Proudly  rejoicing  in  the  fame  of  those  who 
in  their  exalted  position  led  the  court  for  many 
past  generations  in  the  administration  of  a  pure 
and  enlightened  justice,  we  of  this  generation 
are  equally  proud  to  know  that  our  present  chief, 
Andrew  Hunter  Boyd,  maintains  the  high  rank 
of  his  distinguished  predecessors  in  the  command- 
ing qualities  and  endowments  which,  in  symmet- 
rical proportions,  give  us  the  lofty  measure  of  a 
most  accomplished  and  honored  judge  and  gen- 
tleman. 

"His  work  for  16  years  upon  the  bench,  fol- 
lowing a  deservedly  successful  career  at  the  bar, 
justly  entitles  him  to  public  admiration  and 
praise,  and  I  count  it  a  high  privilege  to  be  com- 
missioned by  the  Regents  of  the  University  to 
present  him  to  you  for  the  honorary  degree  of 
Doctor  of  Laws." 

Another  honorary  degree  conferred  was  that 
of  Doctor  of  Divinity  upon  Rev.  John  Timothy 
Stone,  formerly  pastor  of  Brown  Memorial 
Church.  Mr.  Stone  was  not  present.  His  name 
was  presented  by  Judge  Stockbridge. 

The  other  honorary  degrees  conferred  were 
those  of  Master  of  Arts  upon  Mr.  Isaac  Brooks, 
]r.,  and  Doctor  of  Sciences  upon  Dr.  Rupert  Lee 
Blue,  of  the  Marine  Hospital  Service  in  San 
Francisco. 

Mr.  Bernard  Carter,  Provost  of  the  Univer- 
sity, conferred  the  degrees,  the  candidates  for 
which  were  presented  by  the  Deans  of  the  re- 
spective faculties.  Dr.  Wyeth  spoke  mainly  to 
the  graduates  in  medicine,  being  better  ac- 
quainted, as  he  said,  with  what  was  required  of 
that  profession.  A  clean,  healthy  life,  sobriety 
and  self-control,  he  said,  are  most  essential  to 
the  physician.  As  the  greatest  work  of  the  physi- 
cian is  to  prevent,  rather  than  to  cure,  diseases, 
he  also  said,  he  thought  the  ideal  lawyer  is  one 
who  will  settle  disputes,  rather  than  promote  liti- 
gation. 

After  Dr.  Wyeth' s  address  the  names  of  the 
graduates  were  called,  and  they  went  upon  the 


THE   HOSPITAL   BULLETIN 


75 


stage  ami  received  their  diplomas.  Dr.  Thomas 
Fell,  of  St.  John's  College,  which  is  a  part  of  the 
University,  presented  the  candidates  for  the  de- 
gree of  Bachelor  of  Arts  and  Bachelor  of  Sci- 
ences. Dr.  R.  Dorsey  Coale  presented  the  can- 
didates for  the  degree  of  Doctor  of  Medicine; 
Mr.  John  P.  Poe,  the  candidates  for  the  degree 
of  Bachelor  of  Laws;  Dr.  Ferdinand  J.  S.  Gor- 
gas,  the  candidates  for  the  degree  of  Doctor  of 
Dental  Surgery,  and  Dr.  Charles  Caspari,  Jr.. 
the  candidates  for  the  degree  of  Doctor  of 
Pharmacy. 

The  names  of  the  graduates  are  as  follows : 
Bachelor  of  Arts  (all  from  Maryland )— Lloyd  C. 
Bartgis,  J.  Irvin  Dawson,  J.  Alexander  Kendrick,  Ar- 
thur Rufus  Laney,  Harrison  McAlpine,  Allan  H.  St. 
Clair,  Edwin  Warfield,  Charles  L.  Weaver  and  Frank 
H.  Gauss. 

Bachelor  of  Sciences  (all  from  Maryland)— William 
B.  Ennis,  Clarence  T.  Johnson,  R.  Elmer  Jones  and 
Albert   Knox    Starlings. 

DOCTOR  OF  MEDICINE. 
Maryland— Clarence  Irving  Benson,  William  Ward 
Braithwaite,  Norman  Irving  Broadwater,  Arthur  Louis 
Fehsenfeld,  Harry  Baldwin  Gantt,  Jr.,  Morris  Baldwin 
Green,  Joseph  Ward  Hooper,  Samuel  Herman  Long, 
James  Finney  Magraw,  William  E.  Martin,  James  Win. 
Meade,  Jr.,  Wilmer  Marshall  Priest,  William  Gwynn 
Queen,  Louis  Hyman  Roddy,  John  T.  Russell,  John  G. 
Schweinsberg,  Reed  A.  Shankwiler,  Claude  C.  Smink, 
Maurice  Isaac  Stein,  Frederick  Henry  Vinup  and  Wal- 
ter Franklin  Weber. 

Virginia— Carroll  Augustus  Davis,  Julian  Mason  Gil- 
lespie, Preston  Hundley,  Joel  Cutchins  Rawls,  John 
William  Robertson,  Hugh  W.  Smeltzer,  Charles  Frank- 
lin Strosnider  and  Eugene  Bascom  Wright. 

West  Virginia— William  John  Blake,  Simon  Wick- 
line  Hill  and  John  Nelson  Neill  Osburn. 

North  Carolina— Darius  Cleveland  Absher,  Branch 
Craig,  J.  Ernest  Dowdy,  Edgar  Miller  Long,  Ross  Si- 
monton  McElwee,  John  Sanford  Mason,  James  Left- 
wich  Moorefield,  John  Standing  Norman,  Lytle  Neal 
Patrick,  Frederick  Wharton  Rankin,  Nealc  Summers 
Stirewalt,  Charles  LeR.  Swindell,  Asa  Thurston  and 
John  Bruce  Weatherly. 

South  Carolina — Maxey  Lee  Brogdcn,  Paul  Brown, 
Arthur  E.  Cannon,  William  Thornwell  Gibson,  Ever- 
ette  Iseman,  Thomas  Alexander  Patrick,  Furman 
Thomas  Simpson  and  T.  Hayne  Wedeman. 

New  York— William  S.  Campbell,  Edwin  B.  Goodall, 
Harry  M.  Robinson  and  R.  Gerard  Willse. 

New  Jersey — Charles  Herbert  Johnson,  William  Wal- 
ter Kettele  and  Budd  Jameson  Reaser. 

Canada — A.  Marvin  Bell  and  Ralph  Norvel  Knowles. 

Ohio — George  E.  Bennett. 

Florida— Clarence  Bythell  Collins,  James  P.  Parra- 
more  and  Adam  Clark  Walkup. 

Georgia — Robert  H.  Gantt,  Benjamin  Harrison  Gib- 
son and  Lehmon  W.  Williams. 

Rhode  Island — Howard  Barton  Bryer. 


Massachusetts — Arthur  Judson  Cole  ami  Alfred  Chase 
Trull. 

Pennsylvania — Thomas  Robert  Dougher,  James  A. 
Hughes,  Adam  Seanor  Kepple,  John  Lindsey  Mess- 
more,  Charles  A.  Neafie  and  J.  W.  Ricketts 

Delaware — George  Edward   James. 

Minnesota — Howard   Kerns. 

Nebraska — Cleland  G    Moore. 

California — Samuel   Jackson    Price. 

Iowa — Lynn  J.   Putman. 

Cuba — Miguel  A.  Buch  y  Portuondo. 

Porto  Rice — Jose  Y.  de  Guzman  Soto. 

England — Thomas  Gilchrist. 

Syria — Jemil  Abdallah  el  Rassy. 

These  appointments  were  made  to  the  Llni- 
versity  Hospital : 

Resident  Physicians — Joseph  L.  Hooper,  W.  H.  Queen 
and  J.  L.  Robertson. 

Resident  Surgeons— G.  H.  Richards,  T.  M.  West,  N. 
Irving  Broadwater,  Frederick  Rankin  and  James  S.  Mc- 
Graw. 

Resident  Gynecologists — I.  S.  Wilsie  and  C.  C.  Smink. 

Resident   Pathologist— J.   W.   Ricketts. 

Resident  Obstetricians — A.  II.  Hughes,  John  N.  Os- 
born  and  C.  C.  Cannon. 

Resident  Physicians  at  Bayvicw — Branch  Craig,  J.  S. 
Norman  and  11.    I'..  Gantt,  Jr. 

Relief  Fund  for  Dr.  Jas.  Carroll's  Family. 
— It  has  been  suggested  by  some  of  the  alumni 
of  the  University  of  Maryland  that  The  Hos- 
pital Bulletin  should  attempt  to  raise  a  spe- 
cial contribution  to  the  "Relief  Fund  for  Dr. 
James  Carroll's  Family,"  now  being  raised  by 
the  Journal  of  the  American  Medical  Associa- 
tion. The  Bulletin  will  cheerfully  forward  all 
contributions  made  through  it  to  this  fund. 
Any  of  the  alumni  of  the  University  who  desire 
to  contribute  t<>  this  fund  can  do  so  by  for- 
warding their  contribution  direct  to  the  Journal 
of  the  American  Medical  Association  or 
through  The  Bulletin.  The  following  letter 
from  Dr.  S.  W.  Hammond,  class  1905,  explains 
the  situation  : 

"1  would  beg  to  invite  your  attention  to  the 
call  made  on  the  medical  profession  for  'Relief 
of  Dr.  Carroll's  Widow' — Journal  American 
Medical  Association,  April  3rd,  page  1122,  also 
editorial  in  same  issue.  I  want  to  contribute  to 
that  fund,  and  feel  that  every  alumnus  of  the 
University  of  Maryland  would  be  glad  to  con- 
tribute. Dr.  Carroll  had  the  honor  of  being  an 
alumnus,  and  none  the  less  the  U.  of  M.  has 
the  honor  of  being  Dr.  Carroll's  alma  mater. 
It  occurs  to  me  that  it  is  a  rare  opportunity  for 
our  alma  mater,  through  the  alumni,  to  show 
her  appreciation  in  a  substantial  wav. 


76 


THE   HOSPITAL   BULLETIN 


"The  idea  is  to  get  up  a  fund,  say  in  the  name 
of  'Alumni  University  of  Maryland.'  It  will  do 
the  old  University  good.  Not  that  we  would 
be  acting  Pharisee,  hut  fulfilling  that  holy  in- 
junction to  'let  your  light  so  shine,"  etc.  And 
as  an  afterthought,  there  might  as  a  result  be 
established  a  precedent  that,  should  any  alum- 
nus of  the  University  of  Maryland  who  has  de- 
voted his  time,  talent  and  energies  unselfishly 
to  the  advancement  of  science  and  the  protec- 
tion of  the  life  and  health  of  humanity,  such  an 
one  would  feel  encouraged  in  his  altruistic  ef- 
forts. I  believe  that  a  large  number  of  the 
alumni  can  be  reached  through  The  Hospital 
Bulletin.  Details  for  ways  and  means  for  con- 
ducting the  campaign  through  The  Bulletin  I, 
of  course,  leave  to  be  worked  out  by  those  in 
charge,  except  to  say  that  we  can  make  our 
contributions  for  this  fund.  Relief  of  Dr.  Car- 
roll's Widow,  etc..  to  The  Bulletin",  and  the 
amount  be  turned  over  to  the  proper  authori- 
ties as  a  whole,  as  above  indicated.  You  will 
note  in  the  Journal  American  Medical  Associa- 
tion that  all  contributions  are  publicly  acknowl- 
edged in  its  columns.  I  don't  think  we  crave 
anv  self-aggrandizement  by  seeing  our  indi- 
vidual names  set  opposite  our  respective 
amounts  contributed,  but  would  like  to  see  our 
old  alma  mater  do  her  maternal  duty  and  get 
the  honors  she  deservedly  merits." 

Resolutions  to  Prof.  Chew. — In  considera- 
tion of  the  long  and  distinguished  services 
rendered  by  Professor  S.  C.  Chew,  and 
as  an  evidence  of  the  esteem  and  affection 
held  for  him  by  his  colleagues  of  the  Faculty 
of  Physic,  all  of  the  members  of  the  Faculty  in 
the  city  visited  Prof.  Chew  at  his  beautiful 
home,  in  Roland  Park,  on  the  afternoon  of  June 
4th.  and  presented  to  him  through  their  chair- 
man, Prof.  C.  W.  Mitchell,  the  following  reso- 
lutions. 

Professor  Mitchell,  in  presenting  these  reso- 
lutions, made  the  following  remarks : 

"We  all  feel,  dear  Dr.  Chew,  that  something 
more  than  words  of  formal  resolution  should 
be  said  on  this  occasion.  We  come  rather  as 
medical  children  to  a  beloved  father  to  tell  once 
more  our  story  of  gratitude  and  love,  and  to 
seek  counsel  and  advice.  Your  resignation 
severs  the  last  link  that  binds  the  majority  of 
us  to  our  former  teachers,  and  we  are  loth  to 
give  you  up.  Wre  want  to  maintain  the  high 
traditions  which  you  for  so  many  years  have 
typified.      We    still   want   to   breathe   in    your 


spirit.  In  our  sadness  we  have  the  one  con- 
solation that  in  this  beautiful  library  and  home 
you  have  the  solace  of  the  world's  best  thought, 
the  joy  of  religion,  and  the  loving  care  of  a  de- 
voted  family." 

Whereas,  We,  the  members  of  the  Faculty  0/ 
Physic.  University  of  Maryland,  have  received 
with  profound  sorrow  the  resignation  of  our 
revered  and  beloved  colleague.  Prof.  Samuel  C. 
Chew,  and  whereas  his  long  service  has  been 
marked  by  ripe  scholarship,  high  intellectual 
ideals,  rare  charm  and  grace  of  spoken  and 
written  word,  didactic  and  clinical  teaching  of 
singular  power  and  effectiveness,  and  by  a  per- 
vasive moral  force  that  quickened  and  refined 
all  whom  it  touched  ; 

Be  it  Resolved,  That  we  accept  the  resignation 
of  Prof.  Chew  with  great  regret  and  with  the 
deepest  feelings  of  esteem,  affection  and  grati- 
tude :  and  be  it  further 

Resolved,  That  we  wait  upon  Prof.  Chew  in  a 
body  to  personally  extend  these  resolutions  to 
him,  to  request  that  he  accept  the  title  "Emeritus 
Professor  of  Medicine,"  and  to  express  the  hope 
that  his  remaining  years  may  be  spent  in  com- 
fort and  happiness  and  with  the  satisfaction 
which  comes  from  a  long  life  of  high  purpose  and 
great  achievement.     Be  it  further 

Resolved,  That  an  engrossed  copy  of  these 
resolutions  be  forwarded  to  Prof.  Chew,  signed 
by  every  member  of  the  teaching  staff  of  the  Uni- 

versity. 

ALUMNI  DAY. 

Many  of  the  representative  medical  schools  are 
setting  aside  a  day — Alumni — during  their  com- 
mencement exercises  on  which  past  graduates 
are  invited  to  return  and  renew  their  allegiance 
to  their  Alma  Mater.  In  order  to  make  the  visit 
profitable,  instructive  and  sociable,  various  clinics 
are  held,  in  the  specialties  as  well  as  in  general 
medicine  and  surgery ;  the  buildings  are  inspected 
and  class  and  general  reunions  held.  It  is  the 
plan  of  Jefferson  Medical  College  of  Philadel- 
phia, Pa.,  to  celebrate  such  a  day  June  7,  1909. 
A  like  celebration  by  the  University  of  Maryland 
would  be  a  step  in  the  right  direction.  We  are 
doing  a  magnificent  work  of  which  many  of  our 
alumni  are  unaware.  Indeed  a  large  proportion 
of  our  graduates  after  commencement  day  never 
re-enter  the  portals  of  their  Alma  Mater,  conse- 
quently they  have  no  first-hand  knowledge  of 
what  we  are  doing  or  have  accomplished  since 
they  left  us.  If  we  can  provise  means  for  bring- 
ing them  back,  perhaps  they  will  feel  more  kindly 
disposed  to  us.  An  Alumni  Day  would  do  much 
to  accomplish  this ;  at  any  rate  Buffalo  Univer- 
sity. Harvard  University,  University  of  Penn- 
sylvania and  Jefferson  Medical  College  think  so. 
Surely  they  would  be  surprised  at  the  quality 
and  diversity  of  our  work.  If  we  had  a  presi- 
dent, this  is  one  of  the  first  matters  he  would 
take  up.  and  shows  our  crying  need  for  a  direct- 
ing force. 


THE   HOSPITAL  BULLETIN 


77 


ITEMS. 


At  the  annual  meeting  of  the  Medical  and  Chi- 
rurgical  Faculty,  held  at  their  new  building,  121 1 
Cathedral  street,  the  following  of  our  alumni 
were  elected  to  office  for  the  ensuing  year: 
President,  Dr.  G.  Milton  Linthicum,  M.  A.,  De- 
partment Arts  and  Sciences,  St.  John's  College ; 
vice-president,  Dr.  Compton  Riely ;  member  of 
the  Board  of  Trustees,  Dr.  D.  E.  Stone,  class 
of  1864,  Mt.  Pleasant;  councillors,  Dr.  Guy 
Steele,  Cambridge;  State  Board  Medical 
Examiners,  Dr.  Lewis  B  .Henkel,  Annapolis ; 
Dr.  Herbert  Harlan  is  president  of  the  Board 
of  Medical  Examiners  and  Dr.  W.  W.  Golds- 
borough  is  a  member;  delegates  to  American 
Medical  Association,  Dr.  S.  T.  Earle ;  Commit- 
tee on  Scientific  Work  and  Arrangements,  Dr. 
A.  M.  Shipley;  Library  Committee,  Dr.  J.  W. 
Williams ;  Committee  on  Public  Instruction, 
Drs.  M.  C.  Cromwell,  Eugene  Kerr;  Commit- 
tee on  Widows  and  Orphans,  Drs.  E.  F.  Cor- 
dell,  Theodore  Cooke,  Sr. ;  Memoirs  Commit- 
tee, Drs.  J.  T.  Smith,  G.  H.  Cairnes ;  Commit- 
tee on  Medical  Education,  Dr.  Randolph  Wins- 
low;  Sanitary  and  Moral  Prophylaxis,  Dr.  O. 
E.  Janney ;  Committee  on  Tuberculosis,  Drs. 
P.  Travers,  R.  B.  Norment ;  Committee  on 
Pure  Food,  Dr.  N.  R.  Gorter. 


Dr.  Wm.  T.  Watson,  of  Baltimore,  sailed 
June  3  on  steamer  Bremen,  and  will  spend  the 
summer  in  Germany. 


Mrs.  Warren  Grice  Elliott  has  sent  out  invi- 
tations for  the  marriage  of  her  daughter,  Eliz- 
abeth Preston,  to  Dr.  Gordon  Wilson,  on  Sat- 
urday. June  5,  at  6  o'clock,  at  St.  Paul's 
Church,  Baltimore. 


Dr.  and  Mrs.  John  C.  Hemmeter  have  taken 
a  cottage  for  the  summer  season  at  Portland, 
Me. 


Dr.  Rankin,  Dean  of  the  Wake  Forrest  Col- 
lege, North  Carolina,  recently  spent  a  few  days 
in  Baltimore. 


Mrs.  Walter  Levy,  wife  of  Dr.  Walter  V.  S. 
Levy,  is  a  patient  in  the  University  Hospital. 


Dr.  and  Mrs.  Tunstall  Taylor  will  spend  the 
summer  at  Blue  Ridsre  Summit. 


The  Hospital  for  the  Women  of  Maryland, 
among  other  improvements,  will  dedicate  op- 
erating rooms  to  the  memory  of  Dr.  W.  T. 
Howard  and  Dr.  H.  P.  C.  Wilson. 


The  sixty-third  annual  commencement  of 
the  Medical  Department  of  the  University  of 
Buffalo  was  held  May  28,  1909.  Alumni  Day 
was  celebrated  with  appropriate  ceremonies 
May  25,  amongst  which  were  special  clinics  for 
the  alumni  visitors.  This  event  seems  to  be  a 
fixed  feature  of  the  Northern  colleges.  We 
could  imitate  them  with  profit  both  to  our- 
selves and  our  visitors. 


Dr.  John  C.  Hemmeter,  professor  of  physiol- 
ogy in  the  University  of  Maryland,  has  been 
named  as  one  of  the  committee  of  patrons  for 
the  dedication  of  a  monument  to  Michael  Ser- 
vetus,  in  Vienne,  near  Lyons,  France,  August 
14,  1909. 


Dr.  Julian  \Y.  Ashby,  of  Carbon,  W.  Va.,  re- 
cently spent  a  few  days'  vacation  in  Baltimore. 


Dr.  G.  B.  Harrison,  of  Hot  Springs,  Va.,  re- 
cently paid  a  hurried  visit  to  Baltimore. 


Dr.  and  Mrs.  D.  M.  Culbreth  will  spend  the 
summer  sojourning  in  the  North. 


Dr.  and  Mrs.  Wm.  H.  Baltzell  will  occupy 
their  summer  home,  Elm  Bank,  Wellesley, 
Mass.,  for  the  summer  months. 


Dr.  and  Mrs.  Nathan  R.  Gorter  will  summer 
at  the  Chattolanee,  Green  Spring  Valley,  Md., 
where  Dr.  Gorter  is  the  resident  physician. 


Dr.  Eldridge  C.  Price,  class  of  1874,  of  Balti- 
more, read  a  paper  on  "The  Imminent  Danger 
of  Extinction  Which  Threatens  the  Homeo- 
pathic School  in  the  State  of  Maryland  as  a 
Distinctive  Branch  of  the  Medical  Profession ; 
and  the  Remedy,"  before  the  annual  meeting  of 
the  Maryland  State  Homeopathic  Medical  So- 
ciety. 


Dr.  Charles  H.  Riley,  class  of  1880,  de- 
livered the  graduation  address  to  the  nurses 
of  the  Shepperd  and  Enoch  Pratt  Hospital 
School  for  Nurses.  Dr.  Riley  is  vice-president 
of  the  trustees. 


78 


THE   HOSPITAL  BULLETIN 


At  the  commencement  of  the  University  of 
Maryland,  held  at  the  Academy  of  Music  May 
31,  the  honorary  degree  of  LL.  D.  was  con- 
ferred on  Chief  Judge  Boyd,  of  the  Maryland 
Court  of  Appeals,  and  Dr.  John  A.  Wyeth,  of 
New  York,  who  delivered  the  address  to  the 
graduates.  Dr.  Wyeth  is  well  known  as  a 
Confederate  soldier  and  historian,  as  well  as 
for  his  surgical  writings. 


Dr.  Louis  Seth,  assistant  physician  at  Sabil- 
lasville,  has  been  spending  a  few  days  in  Balti- 
more. He  is  looking  hale  and  hearty,  and  re- 
ports that  he  never  felt  better  in  his  life.  His 
looks  do  not  belie  him.  We  are  glad  to  report 
that  he  has  made  such  rapid  strides  toward  the 
resrainal  of  his  health. 


Dr.  A.  A.  Matthews,  class 'of  1900,  of  Spo- 
kane, Wash.,  who  has  recently  been  quite  ill 
with  grip,  we  are  glad  to  report  to  his  friends 
has  entirely  recovered. 


Dr.  George  C.  Winterson,  class  of  1902,  has 
located  at  Red  Cloud,  Nebraska.  The  reports 
are  that  he  is  succeeding  in  building  up  a  nice 
practice. 


Drs.  Charles  W.  Famous  and  Walter  T. 
Messmore,  both  of  the  class  of  1901,  attended 
the  banquet. 


Dr.  James  P.  Parramore,  class  of  1909,  has 
received  an  appointment  as  assistant  resident 
surgeon  at  St.  Joseph's  Hospital,  Baltimore. 


Dr.  Silas  Baldwin,  700  West  Lafayette  ave- 
nue, Baltimore,  was  thrown  to  the  ground  and 
injured  while  driving  in  Druid  Hill  Park,  May 
30,  1909. 


Dr.  Samuel  J.  King,  class  of  1902,  of  Balti- 
more, will  leave  during  the  latter  part  of  June 
to  locate  at  Winnemucca,  Nevada. 


Dr.  J.  C.  Robertson,  class  of  1900,  who  has 
been  quite  ill,  is  reported  to  be  improving. 


E.  P.  Tignor,  D.  D.  S.,  M.  D.,  relieved  from 
temporary  duty  at  Fort  Monroe,  will  proceed 
to  Fort  Slocum,  New  York. 


Dr.  E.  F.  Cordell  delivered  addresses  before 
the  District  of  Columbia  Branch  of  the  General 
Alumni  Association  at  Washington,  April  29, 
and  the  Pennsylvania  Branch  at  York,  May  1. 


The  annual  meeting  of  Baltimore  County 
Medical  Association  was  held  in  Towson,  May 
20.  Dr.  Bennet  F.  Bussey.  1885,  Cockeysville, 
was  elected  president ;  Dr.  Richard  C.  Massen- 
burg,  Towson,  corresponding  secretary;  Dr. 
Josiah  S.  Bowen,  Mount  Washington,  record- 
ing secretary,  and  Drs.  H.  Lewis  Naylor, 
Pikesville,  and  L.  Gibbons  Smart,  Lutherville, 
were  elected  delegates  to  the  Medical  and 
Chirurgical  Faculty  of  Maryland. 


Dr.  Charles  Franklin  Strosnider,  class  of 
1909,  has  been  appointed  assistant  superintend- 
ent of  the  James  Walker  Memorial  Hospital, 
Wilmington,  N.  C. 


Dr.  Martin  L.  Jarrett,  class  of  1864,  of  Balti- 
more, was  recently  elected  commander  of  the 
James  R.  Herbert  Camp,  United  Confederate 
Veterans. 


The  following  of  our  alumni  are  connected 
with  the  Northeastern  Dispensary,  according 
to  their  Fifty-sixth  Annual  Report :  Secretary, 
Dr.  A.  D.  McConachie;  executive  committee. 
Dr.  A.  D.  McConachie;  directors,  Dr.  George 
A.  Hartman,  Dr.  A.  D.  McConachie ;  general 
medicine,  Dr.  P.  E.  Lilly,  class  of  1901  ;  dis- 
eases of  children.  Dr.  A.  L.  Levy;  nose  and 
throat,  Dr.  J.  C.  Robertson ;  eye  and  ear,  Dr. 
A.  D.  McConachie ;  eye  and  ear,  Dr.  J.  S. 
Bowen ;  skin.  Dr.  Fred  Wilkins ;  chief  of  out- 
door clinic,  Dr.  P.  E.  Lilly. 

The  following  of  our  alumni  are  connected 
with  the  South  Baltimore  Eye,  Ear,  Nose  and 
Throat  Charity  Hospital :  Consulting  medical 
and  surgical  staff,  Dr.  Samuel  Theobald,  Dr. 
Hiram  Woods,  Dr.  J.  Frank  Crouch,  Dr.  Chas. 
O'Donovan  ;  assistant  surgeon,  Dr.  J.  F.  Haw- 
kins.   

Dr.  N.  G.  Keirle  is  director  of  the  Pasteur 
Institute,  College  of  Physicians  and  Surgeons ; 
Dr.  Charles  F.  Bevan,  class  of  1871,  is  dean  of 
the  same  school. 


Dr.  and  Mrs.  L.  Ernest  Neale  will  go  to 
Ocean  City  for  the  summer. 

Dr.  G.  Milton  Linthicum,  the  new  president 
of  the  Medical  and  Chirurgical  Faculty,  is  an 
alumnus  of  the  University  of  Maryland,  having 
obtained  a  portion  of  his  collegiate  education 
at  St.  John's  College,  our  department  of  arts 
and  sciences. 


THE   HOSPITAL   BULLETIN 


7i> 


Drs.  T.  A.  Ashby  and  Charles  O'Donovan 
made  addresses  at  the  annual  meeting  of  the 
Medical  and  Chirurgical  Faculty;  Dr.  H.  O. 
Reik  made  the  report  of  The  Bulletin  commit- 
tee; Dr.  J.  L.  Hirsh  read  a  paper  on  "Family 
Epidemic  of  Acute  Trichiniasis ;"'  Dr.  F.  J. 
Kirby  read  a  paper  on  "Tumors  of  the  Carotid 
Gland,  Report  of  a  Case  ;"  Dr.  H.  O.  Reik,  "An 
Atlas  of  Otology,  Illustrated  by  the  Epydia- 
scope :"  Dr.  G.  Timberlake,  "Demonstration  of 
Spirochetae  Pallida  by  Dark  Field  Illumina- 
tion;'' Dr.  R.  II.  Johnston,  "Direct  Laryngo- 
scopy." 


At  the  meeting  of  the  Anne  Arundel  Counts 
Medical  Society,  held  April  16,  at  the  Hotel 
Maryland,  Annapolis.  Dr.  F.  H.  Anderson, 
class  of  1870,  read  a  highly  instructive  and  in- 
teresting paper  on  "The  Treatment  of  Typhoid 
Fever."  Among  those  present  were  Drs.  H.  B. 
Gannt,  Millersville ;  C.  R.  Winterson,  Elk- 
ridge;  L.  P..  Ilenkel,  Annapolis;  J.  S.  Billings- 
lea,  Armiger. 


Dr.  J.  R.  Downs,  class  of  1904,  is  secretary  of 
Caroline  County  Medical  Society. 


At  the  regular  meeting  of  the  Howard  Coun- 
ty Medical  Society,  held  at  the  Howard  House, 
Ellicott  City,  April  6,  1909,  our  alumni  were 
elected  to  the  following  offices  for  the  ensuing 
year:  President,  Dr.  T.  B.  Owings,  class  of 
1852;  vice-president,  Dr.  Wm.  R.  Eareckson. 
Dr.  F.  O.  Miller  was  appointed  one  of  a  com- 
mittee to  secure  a  permanent  meeting  place. 
Dr.  Frank  Janney  addressed  the  society  on  the 
aural  complications  most  frequently  met  with 
following  grip. 


Dr.  Samuel  T.  Earle  will  read  a  paper  on  "A 
Review  of  Proctologic  Literature  for  1908"  at 
the  coming  meeting  of  the  American  Procto- 
logic Society,  to  be  held  at  Atlantic  City,  June 
7.  1909;  also  a  paper  on  "Tubercular  Fistula 
with  Extensive  Infiltration,  with  Specimen  Ex- 
hibited." Dr.  J.  Rawson  Pennington,  class  of 
1887,  of  Chicago,  "Further  Observations  in  the 
Use  of  Bismuth  Paste  in  the  Treatment  of 
Rectal  Fistula." 


Dr.  S.  R.  Donohoe,  class  of  1902,  of  Norfolk, 
Va.,  writes  :  "Two  men  of  the  class  of  1905 — 
H.  E.  Jenkins  and  W.  J.  Riddick — have  passed 
the  examination  for  the  Medical  Department  of 


the  United  States  Navy.  They  stood  the  ex- 
amination in  Washington  last  week,  and 
among  a  number  of  applicants  were  the  only 
successful  candidates.  Things  of  this  sort  mean 
something  for  the  old  University.  We  all  take 
pride  in  the  success  of  the  alumni,  and  their 
friends  will  be  glad  to  hear  of  their  good  for- 
tune." The  editors  desire  to  take  this  occasion 
to  congratulate  both  Drs.  Jenkins  and  Riddick 
on  their  successful  accomplishment  of  a  task 
and  attainment  of  a  position  desired  by  many, 
but  actually  realized  by  less  than  20  per  cent, 
of  those  taking  the  examinations.  It  i^  such 
men  as  these  that  reflect  credit  upon  those  who 
have  taught  them  and  their  alma  mater. 


We  have  heard  that  Dr.  A.  D.  Tuttle.  class 
of  1906,  a  veteran  of  the  Filipino  and  Chinese 
Wars,  and  withal  a  good  fellow  and  student, 
has  successful!}'  passed  the  Army  Medical  Ex- 
amining Board  and  is  now  a  first  lieutenant  in 
the  Medical  Corps,  United  States  Army.  We 
also  extend  to  Dr.  Tuttle  our  congratulations 
upon  his  success,  and  hope  that  if  the  occasion 
offers  he  will  shed  as  much  lustre  upon  his 
school  as  Carroll  and  Victor  Ruppert  Blue. 


Commencement  exercises  took  place  at  St. 
John's  College  (Department  Arts  and 
Sciences).  Annapolis,  June  1 1  to  June  16.  Of 
particular  interest  was  the  celebration  of  the 
one  hundred  and  twenty-fifth  anniversary  of 
the  chartering  of  St.  John's  College  as  a  colle- 
giate institute.  St.  John's  was  founded  as  King 
William's  School  in  1G89,  and  in  1784  it  was 
merged  into  St.  John's  College.  Only  Har- 
vard, at  Cambridge.  .Mass.,  and  William  and 
.Marv,  at  Williamsburg,  Va.,  antedate  St. 
John's  in  their  beginnings  as  institutions  of 
learning. 

The  exercises  commemorative  of  the  found- 
ing of  the  college  will  take  place  on  Wednesday, 
June  16,  the  same  day  that  the  class  graduates. 
(  )ver  50  of  the  leading  institutions  of  learning 
of  the  country  will  be  represented  by  their 
presidents  or  prominent  members  of  the  faculty 
or  alumni.  The  list  includes  all  of  the  institu- 
tions in  this  vicinity,  with  most  of  the  others 
throughout  the  country  which  are  notable  for 
their  historic  interest  or  on  account  of  their 
prominence  in  the  intellectual  life  of  the  nation. 

x\bout  15  graduates  will  receive  degrees  of 
bachelor  of  arts  and  bachelor  of  science,  while 
a  number  of  distinguished  alumni  and  others 
will  receive  honorary  degrees,  among  whom  is 
Dr.  Randolph  Winslow,  who  receives  an 
LL.D. 


80 


THE   HOSPITAL  BULLETIN 


Dr.  Taylor  E.  Darby,  class  of  1904,  is  located 
at  Barnesville,  Montgomery  county,  Md. 


Dr.  C.  Urban  Smith  is  connected  with  the 
Faculty  of  the  Maryland  Medical  College. 


Dr.  Louis  H.  Seth,  formerly  assistant  resi- 
dent physician  in  the  hospital,  is  at  present  as- 
sistant resident  physician  in  the  Tuberculosis 
Sanitarium,  Sabillasville.  Dr.  John  C.  Hem- 
meter  delivered  the  address  of  the  occasion  to 
the  graduates  of  the  Hebrew  Hospital  Training 
School  for  Nurses.  Amongst  others  who  spoke 
were  Drs.  J.  L.  Hirsh  and  Harry  Adler,  who, 
with  a  few  appropriate  words,  distributed  the 
diplomas. 


Dr.  and  Mrs.  Eugene  Raphel.  of  Wheeling, 
W.  Va.,  have  been  the  guests  of  Miss  Edgarina 
Hastings,  niece  of  Judge  Martin  Morris,  with 
whom  she  makes  her  home  at  13 14  Massachu- 
setts avenue,  Washington,  D.  C. 


Dr.  Robert  W.  Crawford,  class  of  1906,  of 
Rocky  Mount,  N.  C,  paid  the  city  and  the  Uni- 
versity Hospital  a  visit  recently. 


Dr.    James   Taylor,    of   North    Carolina,    re- 
cently stopped  at  the  University  Hospital. 


Mr.  and  Mrs.  Alfred  Courtney  Doyle,  of  The 
Hylands,  Walbrook,  have  announced  the  en- 
gagement of  their  daughter,  Agnes  Hegg,  to 
Dr.  John  Wilson  MacConnell,  of  Davidson,  N. 
C,  formerly  resident  physician  at  the  Presby- 
terian Eye,  Ear  and  Throat  Hospital,  Balti- 
more. 


The  residents  and  graduating  class  of  the 
University  of  Maryland  Medical  School  re- 
cently gave  a  farewell  dance  at  Albaugh's  The- 
atre in  honor  of  the  nurses  of  the  University 
Hospital.  Among  those  present  were :  Misses 
Wilson,  Wright,  Israel,  Chapline,  Almond,  Ely, 
Barrett,  Murchoin,  Robey,  Tess.  Salisbury, 
Garrison,  Tull,  Kimmel ;  Drs.  Bird,  Hammond, 
J.  H.  Bay,  Kolb,  Coleman  and  West ;  Messrs. 
Hooper,  Wright,  Gannt,  Queen,  Broadwater, 
Ricketts,  Moorefield.  Brown.  Mason,  Osborn 
and  Kirk. 


A  memorial  service  was  held  at  Central 
Young  Men's  Christian  Association  for  Dr.  E. 
T.  Duke. 


Dr.  G.  B.  Harrison  is  superintendent  of  the 
Green  Brier  General  Hospital,  Ronceverte.  \Y. 
Va. 


Dr.  Hiram  Woods  presided  at  the  second 
annual  meeting  of  the  Maryland  Society  of 
Social  Hygiene. 


The  annual  reunion  of  the  Medical  Alumni 
Association  of  the  University  of  Maryland  and 
banquet  were  held  at  the  Eutaw  House,  Balti- 
more, Md..  Monday  night,  May  31.  1909.  At  the 
business  meeting  Dr.  Thomas  M.  Chaney,  the 
president  presided,  and  in  the  absence  of  Dr. 
Sadtler,  the  secretary,  Dr.  James  M.  Craighill 
acted  pro  tern.  Several  new  members  were 
elected  to  membership.  Dr.  Cordell  reported 
that  the  endowment  fund  now  amounted  to  a 
little  over  $19,000.  A  few  reminiscent  remarks 
were  indulged  in  by  Drs.  Cordell.  Taneyhill 
and  Ashby.  A  motion  to  disband  the  associa- 
tion and  amalgamate  with  the  General  Alumni 
Association  was  proposed,  but  defeated.  This 
motion  brought  forth  a  heated  discussion,  both 
pro  and  con. 

Officers  for  1909-10  were  elected  as  follows : 
President,  Wm.  H.  Pearce,  M.  D. ;  vice-presi- 
dents, Guy  Steele,  M.  D.,  Joseph  Smith,  M.  D., 

A.  C.  Pole,  M.  D. ;  recording  secretary,  Charles 
E.  Sadtler,  M.  D. ;  assistant  recording  secre- 
tary, J.  F.  H.  Gorsuch,  M.  D. ;  corresponding 
secretary,  John  Houff,  M.  D. ;  treasurer,  John 
I.  Penington,  M.  D. ;  executive  committee,  A. 
D.  McConachie.  M.  D.,  Geo.  H.  Hocking,  M. 
D.,  C.  A.  Winterson,  M.  D„  B.  M.  Hopkinson, 
M.  D.,  G.  Lane  Taneyhill,  M.  D. 

The  banquet  was  enlivened  by  solos  by  Dr. 

B.  Merrill  Hopkinson  and  Mr.  Lynn  Hobart. 
During  the  courses  Hesse's  Orchestra  dis- 
pensed music.  About  150,  including  the  grad- 
uating class,  which  was  the  guest  of  the  medi- 
cal faculty,  were  present. 


Dr.  A.   E.   Landers  is  located  at   Crumpton, 
Md. 


Dr.  K.  M.  Jarrell,  class  '06.  is  now  practicing 
in  Clear  Creek.  YV.  Ya.  Dr.  Jarrell  writes  that  he 
has  built  up  a  large  practice  and  is  having  fine 
success.  He  has  recently  been  appointed 
health  officer  for  Raleigh  count}-,  W.  Va.,  for 
four  years,  with  a  fair  salary  attached.  He  ex- 
pects to  visit  Baltimore  during  the  present 
month. 


Dr.  J.  A.  Devlin,  class  of  1906,  writes  in  part: 
''I  am  sending  you  a  copy  of  the  report  of  St. 
Francis  Hospital,  of  which  I  am  now  house 
surgeon.  I  should  have  been  in  this  illustrious 
position  a  year  ago,  but  spent  most  of  the  year 
of  1007  in  bed.  the  rest  in  sulphur  baths  at 
Richfield  Springs.  I  had  acute  articular  rheu- 
matism and  the  •trimmings  on  the  endocardium 
which  go  with  it.  Altogether  had  a  very  nice 
part}-.  I  resumed  my  work  here  January  1st, 
1908.  I  get  Tin-:  Bulletin  regularly,  and  it  is 
very  interesting  to  me.  I  often  wish  I  could 
stop  work  for  a  while  and  pay  a  visit  to  you  all, 
and  perhaps  aid  in  coaching  a  team  (football) 
to  beat  Hopkins. 


THE   HOSPITAL  BULLETIN 


81 


DEATHS. 
Dr.  Benjamin  F.  Lansdale,  64  years  old,  lor 
40  years  a  practising  physician  at  Damascus, 
Md.,  died  May  21,  1909,  at  his  home,  in  Damas- 
cus, of  cancer  of  the  stomach.  Surviving  him 
is  a  widow,  who  was  a  daughter  of  the  late  Phil- 
emon M.  M.  Smith,  of  Gaithersburg,  and  three 
children — Dr.  P.  Smith  Lansdale,  of  Ohio;  Mrs. 
John  Lewis  and  Mrs.  Beall,  of  Damascus.  Dr. 
Lansdale  was  born  in  Washington  and  was  a 
son  of  the  late  Henry  Nelson  Lansdale,  of  that 
city.  He  was  educated  in  Washington  and 
Baltimore,  and  was  graduated  from  the  Uni- 
versity of  Maryland,  class  of  1866,  beginning 
the  practice  of  his  profession  soon  afterward. 


Dr.  Willis  Alston,  class  of  1869,  a  member 
of  the  Medical  Society  of  the  State  of  North 
Carolina,  and  one  of  its  founders,  for  six  years 
a  member  of  the  State  Board  of  Medical  Ex- 
aminers, died  at  his  home,  in  Littleton,  April 
20,  1909,  aged  62. 


Dr.  Charles  W.  Harper,  class  of  1869,  one  of 
the  best-known  residents  of  Halethorpe,  Md., 
died  May  14,  1909,  at  his  home,  from  infirmities 
of  old  age.  Dr.  Harper  was  about  70  years  old 
and  had  practiced  medicine  in  Halethorpe 
many  years.     He  is  survived  by  his  wife. 


Dr.  John  Kilgour  White,  class  of  1884,  of 
Woodland,  Md.,  died  suddenly  from  pneumonia 
April  4,   1909. 


Dr.  Roger  Brooke,  class  of  1887,  of  Sandy 
Springs,  Md.,  62  years  old,  for  many  years  a 
leading  physician,  died  May  9,  1909.  He  had 
an  attack  of  acute  indigestion  about  April  1. 
and  this  developed  into  a  heart  weakness  which 
caused  his  death. 

Dr.  Brooke  was  highly  regarded  for  skill  and 
faithfulness  in  practice.  He  participated  in  all 
public-spirited  enterprises,  being  a  most  active 
spirit  in  the  organization  of  the  Enterprise  Tel- 
ephone Company,  a  local  corporation,  and  was 
its  president  and  general  manager  for  several 
years,  and  was  president  at  the  time  the  com- 
pany was  sold  to  the  Chesapeake  and  Potomac 
Company  a  few  years  ago.  At  the  time  of  his 
death  he  was  a  member  of  the  committee  hav- 
ing in  charge  the  construction  of  the  high 
school  building  here.  The  good-roads  question 
interested  him  deeply,  and  he  earnestly  partici- 
pated in  every  effort  directed  toward  abolishing 
tollgates.  lie  was  an  active  member  of  Mont- 
gomery County  Medical  Society  and  had 
served  as  its  president. 

Surviving  him  are  his  widow,  Mrs.  Louisa 
T.  Brooke,  and  five  children — Mrs.  Emilie  B. 
Coulter,  Miss  Sallie  Brooke,  of  Sandy  Spring; 
Mrs.  N.  G.  Smith,  of  Auburn,  Me.:  Dr.  Roger 
Brooke,  an  army  surgeon,  and  Edward  T. 
Brooke. 


The  funeral  took  place  May  11,  1909,  from 
the  family  residence,  and  was  attended  by  one 
of  the  largest  gatherings  ever  seen  at  a  funeral 
in  that  section  of  the  county.  The  services 
were  those  of  the  orthodox  branch  of  the  So- 
ciety of  Friends,  of  which  Dr.  Brooke  was  a 
prominent  member.  Walter  Brooke,  Caleb 
Stabler,  Tarlton  Brooke  and  Fred  L.  Thomas, 
nephews  of  Dr.  Brooke,  and  Joseph  Janney  and 
Dr.  George  E.  Cooke  were  the  pallbearers.  The 
interment  was  in  Woodside  Cemetery,  near 
Ashton. 

Oh,  why  has  worth  so  short  a  date?  It  is 
only  the  loss  of  such  a  man  as  Roger  Brooke 
that  can  teach  his  mourners — who  comprise  all 
who  knew  him — what  was  his  real  value  to  the 
people  among  whom  he  lived.  It  is  no  dispar- 
agement to  those  who  are  left  to  say  that  there 
is  no  other  person  in  the  entire  neighborhood 
who  could  so  ill  have  been  spared.  As  a  citizen 
he  performed  his  full  duty,  taking  a  prominent 
part  in  measures  for  the  benefit  and  uplift  of 
the  community;  as  a  man  he  won  the  respect 
and  warm  friendship  of  a  large  circle,  always 
being  guided  by  what  he  believed  to  be  right ; 
as  a  husband  his  life  for  nearly  forty  years  was 
the  highest  type  and  example  of  consistent  de- 
voted love ;  as  father  and  grandfather  he  com- 
bined wise  counsel  with  affectionate  tender- 
ness, so  that  the  grief  of  his  children  may  well 
be  tempered  by  thankfulness  that  they  are  sons 
and  daughters  of  such  a  parent ;  as  a  true  fol- 
lower of  Christ  he  was  a  comforter  to  many  in 
their  hours  of  bereavement  by  his  words  of 
deep  feeling  and  simple  eloquence,  while  his 
sincere  religious  nature  was  shown  in  all 
church  work — as  a  physician — though  he  did 
not  take  up  that  vocation  until  late  in  life,  and 
against  the  advice  of  nearly  all  his  friend: — his 
sucess  was  marvelous.  I  do  not  speak  of  that 
poor  sort  of  success  which  is  measured  by  dol- 
lars and  cents,  but  veal  success,  manifested  by 
saving  lives,  relieving  suffering  and  distress,  and 
making  the  world  better  and  happier  because 
of  his  having  lived  in  it.  How  many  families 
have  had  intense  anxiety  changed  to  comfort 
and  reassurance  by  his  efficient  ministrations  ! 
And  with  what  forebodings  we  now  face  the 
future !  The  martyr's  crown  grows  dim  and 
lusterless,  the  hero's  wreath  fades  and  withers, 
compared  with  such  services  as  he  rendered 
during  his  long  years  of  practice.  Perhaps  the 
exposure  during  the  stormiest  night  of  last 
winter  may  have  hastened  his  end,  but  there 
was  no  more  thought  of  failure  to  respond  to 
the  call  of  duty  than  if  he  had  been  a  patriotic 
soldier  on  a  battlefield. 

It  is  not  for  us  weak  mortals  to  understand 
why  a  life  so  full  of  usefulness  in  so  many 
varied  fields  should  be  stricken  down  when 
hardly  beyond  its  prime ;  we  only  know  that 
"God's  finger  touched  him  and  he  slept." 

Alan  Farquhar, 


(Inflammation's  cAntidote) 


&&>*» 


applied  from  ear  to  ear  as  hot  as  can  be  born 
comfortably  by  the  patient,  depletes  the  enlarged 
lymph  glands,  guards  against  the  passage  of 
toxines  into  the  circulation  and  reduces  the  lia- 
bility of  Mastoiditis,  Middle  Ear  and  Laryngeal 
complications  in  Tonsilitis,  Scarlatina,  and  other 
diseases  of  similar  nature. 

The  dressing  of  Antiphlogistine  must  be 
at  least  an  eight  of  an  inch  thick,  covered  with 
a  plentiful  amount  of  absorbent  cotton  and  held 
snugly  in  place  by  a  bandage. 

THE  DENVER  CHEMICAL 
MFG.   CO.  New  York 


ERTAIN  as  it  is  that  a  single  acting  cause  can  bring 
about  any  one  of  the  several  anomalies  of  menstrua- 
tion, just  so  certain  is  it  that  a  single  remedial  agent 
—  if  properly  administered  —  can  effect  the  relief  of 
any  one  of  those  anomalies. 

<|  The  singular  efficacy  of  Ergoapiol  (Smith)  in  the 
various  menstrual  irregularities  is  manifestly  due  to  its  prompt 
and  direct  analgesic,  antispasmodic  and  tonic  action  upon  the 
entire  female  reproductive  system. 

<I  Ergoapiol  (Smith)  is  of  special,  indeed  extraordinary,  value  in 
such  menstrual  irregularities  as  amenorrhea,  dysmenorrhea, 
menorrhagia  and  metrorrhagia. 

•I  The  creators  of  the  preparation,  the  Martin  H.  Smith 
Company,  of  New  York,  will  send  samples  and  exhaustive 
literature,  post  paid,  to  any  member  of  the  medical  profession. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department   of  the  University  of  Maryland 

PRICE     $1.00     PER     YEAR 


Contributions  invited  from  the  Alumni  of  the  University. 
Business  Address,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter. 


Vol.  V 


BALTIMORE,   MD.,  JULY  15,  1909. 


No.  5 


MEDICAL  ETHICS. 

An  Address  Delivered  Before   the   University   of 

Maryland  Medical  Association 

By  Samuel  C.  Chew,  M.  D.,  LL.  !>., 

March  16,  1909. 

The  subject  of  Professional  Ethics  is  not  in- 
cluded  in  our  curriculum  for  undergraduates,  nor 
has  it  a  place  in  the  post-graduate  course  of  which 
it  might  properly  form  a  part;  and  yet  it  is 
worthy  of  attention  as  having  an  important  hear- 
ing upon  our  professional  duties. 

Let  us  first  consider  what  is  meant  by  the  term 
Ethics.  The  meaning  of  a  word  is  often  best 
ascertained  by  studying  its  etymological  origin, 
and,  although  many  words  may  have  wandered 
by  a  sort  of  evolutionary  process,  as  it  were,  from 
their  first  signification,  yet  the  tracing  of  the 
gradual  changes  may  he  interesting  and  may  show- 
how  the  real  and  full  meaning  has  been  acquired, 
and  sometimes  how  it  has  been  lost. 

The  word  Ethics  is  derived  from  the  Greek 
«#°s,  or  ^#05,  which  are  close  of  kin,  and 
though  not  precisely  alike  they  have  a  common 
origin,  «0os  meaning  a  custom,  usage  or  habit 
and  »|0os  meaning  primarily  an  accustomed 
seat,  whether  an  abode  of  men  or  a  haunt  or  lair 
of  beasts  to  which  they  resort,  and  thus  later 
coming  also  to  signify  custom  or  habit,  and  from 
this,  disposition  and  character  as  formed  by  habit. 
Both  words  are  perhaps  traceable  to  e£o//.ai(  to 
sit,  and  thus  related  to  the  Latin  sedeo,  and  prob- 
ably through  a  remote  common  ancestry  of  the 
Indo-European  stock  to  the  English  sit.  Now, 
as  habits  of  thought,  temper  or  morality  tend  to 
form  character,  it  can  be  seen  how  the  subject  of 
Ethics  embraces  the  consideration  of  the  things 
that  tend  to  good. 

But  it  may  be  said  that  though  good  habits 
tend  to  form  good  character,  yet  bad  habits  form 
bad  character,  and  why,  then,  should  the  term 
Ethics,  when  used  absolutely  and  without  quali- 
fication, relate  to  the  influences  which  form  good 
character,  ethical  meaning  what  accords  with  pro- 


priety, while  what  does  not  so  accord  is  unethical. 
Ethical  conduct  is  proper  conduct;  unethical  the 
reverse.  In  Bentham's  phrase,  "Ethics  may  be 
defined  the  art  of  directing  men's  actions  to  the 
production  of  the  greatest  quantity  of  happi- 
ness." lie  ilocs  not  connect  with  it  at  all  the  idea 
of  unhappiness  or  of  any  evil.  When  it  is  said 
that  ethics  is  the  science  of  morals,  the  same 
thought  is  suggested  regarding  the  words  "mor- 
als" and  "morality,"  which  originally  and  etymo- 
logically  signified  what  was  good  or  bad  in  man- 
ners and  practices,  hut  acquired  and  kept  after- 
wards a  good  meaning  when  used  absolutely,  so 
that  morality  in  a  person  implies  rectitude  of 
character  and  immorality  the  reverse. 

And  thus  it  would  appear  that  words,  like  or- 
ganisms, may  tend  to  improve  upon  their  original 
condition  and  acquire  an  invariably  good  mean- 
ing which  they  had  not  at  first,  and  it  may  be 
shown  that,  like  organisms,  they  may  undergo  a 
process  of  degeneration.  Happily,  the  words 
"Ethies"  and  "Ethical"  have  attained  and  kept 
a  good  ining  and  are  restricted  to  such  mean- 
ing when  used  in  reference  to  conduct  or  charac- 
ter. 

And  here  take  that  very  interesting  word  cliar- 
nctcr  itself,  which  originally  and  etymologically 
ms  a  neutral  signification  either  good  or  bad,  as 
modified  by  adjectives,  and  yet  when  used  abso- 
lutely and  by  itself  has  generally  a  good  sense, 
so  that  when  we  speak  of  a  man  of  character  we 
mean  a  man  of  good  character.  Trace  for  a  mo- 
ment the   family   history  of   this  word   character. 

It  comes  from  the  Greek,  xaPaKTVP  an  instru- 
ment for  marking,  and  that  from  xaP^<TO'u>, 
to  sharpen,  which  itself,  so  philology  tells  us,  is 
akin  to  our  homely  word  scratch.  It  would  seem 
a  far  cry  from  a  scratch  to  a  character,  and  yet 
the  passage  from  the  one  to  the  other  can  be 
traced  along  the  devious  Indo-European  path;  a 
path  which,  though  arid  to  some,  may  at  times 
Je  found  full  of  delightful  surprises.  For  the 
instrument,  the  XaPaKT1ip  makes  markings  and 
thus  impresses  qualities    or   distinctive   charac- 


84 


THE  HOSPITAL  BULLETIN 


teristics,  and  the  best  of  these  survive  when  the 
word  is  used  absolutely  and  form  a  good  charac- 
ter, a  thing  that  is  marked  with  good.  Now  take 
some  instances  of  degeneration  in  words,  as  show- 
ing how  they  may  lose  their  good  meaning  and 
get  a  bad  one.  In  early  English  and  down  to  a 
comparatively  recent  time  the  word  temper  was 
used  to  indicate  governance  of  disposition  or  re- 
straint of  excitability,  so  that  one  engaged  in  a 
quarrel  or  a  controversy  was  said  to  display  tem- 
per if  in  reply  he  governed  his  tongue  or  his  pas- 
sion. This  proper  use  showed  the  origin  of  the 
word  from  the  Latin  temperare,  to  be  moderate, 
to  restrain  one's  self,  and  it  is  illustrated  by  a 
line  from  Pope : 

"Teach  me,  like  thee,  in  various  nature  wise, 
To  fall  with  dignity,  witli  temper  rise." 

But  now  the  very  opposite  meaning  prevails, 
and  one  who  gives  way  to  angry  passion  is  said 
to  show  a  great  deal  of  temper,  the  word  having 

undergone  a   degeneration   from    its    former  g I 

meaning. 

Another  instance  of  such  degradation  is  found 
in  the  word  "nervous,"  derived  from  the  Latin 
nervosus,  itself  from  nervus,  which  in  classic  Latin 
did  not  mean  a  nerve  hut  a  sinew,  and  stood  for 
strength  and  vigor,  and  hence  the  English  word 
meant  '"well-strung,"  "strong,"  "vigorous,"  and  is 
illustrated  by  another  line  of  Pope's: 

"What  nervous  arms  he  boasts:  how  linn  he 
treads." 

But  now  the  meaning  is  in  common  speech  often 
reversed,  though  this  is  hardly  sanctioned  by  good 
writers,  and  the  word  is  used  to  indicate  a  condi- 
tion of  weak  or  irritable  nerves.  And  yet  I  do 
not  think  that  Dr.  Johnson  is  altogether  fair  in 
referring  to  this  use  as  belonging  to  what  he 
calls  "medical  cant,"  for  educated  physicians  do 
not  employ  the  word  nervous  in  this  way  either 
in  writing  or  in  speech.  It  is,  of  course,  proper 
to  speak  of  the  "nervous  system"  and  of  "nervous 
centres,"  for  that  is  a  legitimate  use  of  the  word, 
indicating  a  system  composed  of  nerves  or  cen- 
tres composed  of  nerve  cells.  And  yet  the  fre- 
quency with  which  the  word  "nervous"  is  used  to 
connote  a  lack  of  nerve  control  shows  a  degrada- 
tion from  its  proper  use. 

And  now,  going  hack  to  words  which  have  ac- 
quired and  retained  a  good  meaning,  we  find  that 
the    terms    "Ethics"    and    Ethical"   relate    to   the 


practice    of    those    customs   or    usages    which    are 
right  and  proper  and  thus  belong  to  good  charac- 
ter. 

Now  the  subject  of  medical  ethics,  or  the  con- 
dition of  things  in  our  profession  which  is  in 
accordance  with  proper  courtesies  and  proper  char- 
acter, may  be  considered  under  two  heads: 

first — The  ethics  or  proper  courtesies  to  lie 
observed  towards  our  professional  brethren  and 
as  regulating  our  relations  with  them:  and 

Secondly,  the  ethics  or  proper  courtesies  to  be 
observed  towards  the  community  at  large,  and 
especially  those  who  apply  to  us  for  professional 
counsel. 

Under  the  first  are  to  lie  considered  the  claims 
which  physicians  as  such  have  upon  each  other. 
One  of  these  is  the  claim,  for  so  it  may  be  called 
as  being  fixed  by  usage,  for  professional  attend- 
ance without  remuneration,  which  springs  partly 
from  the  esprii  de  corps,  the  spirit  which  should 
govern  physicians  as  belonging  to  the  samebrother- 
hood  :  and  such  attendance  is  customarily  given 
also  to  those  members  of  a  physician's  immediate 
family  who  are  dependent  upon  him,  but  not  fur- 
ther. There  may  be  exceptions  to  this  rule,  as 
in  the  case  of  wealthy  physicians,  especially 
where  the  wealth  is  not  the  result  of  professional 
Labors,  hut  has  come  from  outside  sources.  But 
even  then  it  is  most  in  accordance  with  the  spirit 
of  our  calling  that  the  demand  should  not  be 
made  nor  the  expectation  shown,  but  that  the 
subject  should  he  left  to  the  beneficiary's  own 
sense  of  justice,  when,  if  remuneration  be  ten- 
dered, it  need  not  lie  refused.  Again,  if  services, 
especially  when  they  have  been  of  an  exacting 
character  and  have  consumed  much  time,  have 
been  rendered  to  a  physician  who  at  his  death 
should  have  left  a  large  estate,  it  would  be  en- 
tirely proper  to  render  an  account  against  the 
estate:  for  the  usage  of  professional  courtesy  is 
personal,  terminating  with  death,  and  does  not 
exist  as  to  a  family  who  are  wealthy  and  who  have 
no  claim  of  courtesy  against  the  attendant.  The 
case  is  wholly  different  where  a  family  are  left 
with  only  narrow  or  moderate  means;  but  that 
rests  rather  upon  grounds  of  humanity  than  of 
courtesy. 

In  general  the  claim  for  service  on  the  part  of 
one  physician  upon  another  continues  when  the 
recipient  is  permanently  incapacitated  by  age  or 
sickness,  but  if  the  medical  profession  is  aban- 
doned for  some  other  the  claim,  of  course,  ceases 
to  exist. 


THE  HOSPITAL  BULLETIN 


85 


Another  ground  upon  which  the  usage  of  free 
professional  services  may  rest  is  that  of  reciprocity, 
for  what  is  gratuitously  rendered  should  be  gra- 
tuitously returned:  "Freely  ye  have  received, 
i  reely  give." 

Another  ethieal  subject  as  between  physicians 
relates  to  conduct  in  consultations.  These  art- 
held  in  general  for  one  or  other  of  two  reasons — 
the  first  when  a  young  practitioner  from  inex- 
perience really  needs  assistance;  the  other  in 
specially  important  and  gra>ve  eases  to  share  and 
divide  responsibility,  or  because  of  a  natural  de- 
sire on  the  part  of  the  patient  or  his  family  for 
more  opinions  than  one.  In  either  case  the  con- 
sultant, if  he  find  an  error  in  diagnosis  or  treat- 
ment, should  feel  bound  in  ethics  to  protect  bis 
colleague's  professional  reputation  and  ''to  hide 
the  fault  he  sees;"  and  this  can  always  be  done 
without  violation  of  truth. 

The  consultant  who  suggests  a  change  of  treat- 
ment which  he  knows  to  be  needless  is  chargeable 
with  dishonesty,  and  wit!)  the  desire  of  having 
it  thought  that  he  knows  more  than  he  really  does. 
He  is  as  one  who 

"Hints  a  doubt  and  hesitates  dislike, 
Willing  to  wound  and  yet  afraid  to  strike." 

Secondly,  as  regards  the  relations  held  to  the 
general  community,  it  may  be  said  in  passing  that 
such  matters  as  gratuitous  professional  services  to 
ministers  of  religious  bodies  because  of  the  work 
in  which  they  are  engaged,  or  to  the  poor  on  ac- 
count of  their  poverty,  are  not  properly  ethical 
and  do  not  belong  to  the  subject  of  ethics,  but 
rather  to  that  of  humanity,  and  every  individual 
case  must  be  considered  upon  its  own  merits.  I 
would  only  refer  in  this  connection  to  a  saying 
of  the  wise  and  good  Dr.  Fothergill,  that  the  poor 
were  his  best  patients  because  the  Lord  was  the 
paymaster. 

An  important  question  in  our  relations  with  the 
general  public  is  that  of  the  obligation  to  secrecy 
as  to  subjects  of  which  we  have  knowledge  only 
as  physicians  through  professional  confidence.  I 
believe  that  the  clergy  are  protected  by  law  against 
compulsion  to  reveal  things  which  they  have 
learned  through  the  confessional,  and  some  moral- 
ists hold  that  they  are  justified  in  disavowing  all 
knowledge  thus  obtained ;  that  it  is  simply  as 
though  it  were  not  known.  A  story  is  told  of  a 
priest  to  whom  the  crime  of  murder  had  been 
formally  confessed,  and  when  in  a  subsequent  con- 


versation bis  penitent  began  to  speak  of  the  case, 
"Stop!"  said  the  priest;  "do  not  say  a  word;  this 
is  not  the  confessional,  and  should  I  be  called 
as  a  witness  anything  that  you  may  now  say  1, 
could  be  compelled  to  reveal."  Now-  it  may  be 
belli  that  the  like  protection  should  be  given  to  a 
physician  who  as  a  physician  has  learned  things 
which  it  would  be  to  the  injury  or  the  discredit 
of  his  patient  to  have  disclosed.  I  do  not  know 
whether  any  such  ease  has  been  ruled  upon. 


RENAL  CALCULUS. 

.1/;  Address  before  the  Doctors'  Class  at  the  Uni- 

versity  Hospital  on  January  29,  1909. 

Hy  Randolph  Winslow,  A.  M.,  M.  D. 

CAUSES. 

Tin'  causes  of  urinary  calculus  wherever  it  may 
li  located  are  both  constitutional  and  local.  Stones 
in  the  kidney  arc  generally  dependent  upon  some 
constitutional  dyscrasia,  whilst  those  in  the  urinary 
bladder  are  frequently  due  to  local  conditions. 
Normally  the  the  inorganic  salts  are  held  in  solu- 
tion in  the  urine,  but  when  the  urine  becomes 
too  highly  concentrated  or  of  too  great  acidity 
crystals  are  formed,  which  may  lodge  in  some 
portion  of  the  urinary  tract  and  by  accretion  be- 
come calculi.  The  constitutional  conditions  that 
most  frequently  are  productive  of  stone  are  gout, 
rheumatism,  impaired  digestion,  improper  food 
and  unhygienic  modes  of  life,  whilst  the  local 
causative  factors  are  foreign  bodies,  obstructive 
lesions  of  the  lower  urinary  channels,  such  as 
stricture  of  the  urethra  and  hypertrophy  of  the 
prostrate  gland,  with  infection  of  the  bladder 
Renal  calculus  naturally  depends  upon  a  consti- 
tutional rather  than  a  local  cause  in  the  vast  ma- 
jority of  eases,  but  in  a  few  instances  foreign 
ho.lies  have  become  lodged  in  the  kidney  and  have 
been  the  nuclei  of  stones:  thus,  a  case  is  recorded 
in  Dennis'  System  of  Surgery,  where  a  needle, 
which  had  been  swallowTed  many  years  previously, 
had  found  its  way  into  the  kidney  and  had  become 
encrusted  with  salt.  It  would  be  quite  possible 
that  bullets,  spicules  of  bone  or  other  foreign  bod- 
ies might  in  some  instances  become  lodged  in  the 
kidney  and  form  calculi. 


86 


THE  HOSPITAL  BULLETIN 


VARIETIES. 

There  are  three  great  varieties  of  calculi — the 
uric  acid  and  water,  the  oxalate  of  lime  and  the 
phosphatic — but  they  seldom  consist  of  one  salt 
and  arc  usually  mixed  in  composition.  Rarer 
forms  of  calculi  are  the  calsium  carbonate,  cystin, 
Xanthin  and  indigo.  Renal  calculi  are  generally 
of  the  uric  acid  or  oxalate  of  lime  varieties,  but 
when  infection  of  the  pelvis  occurs  phosphatic 
stones  are  liable  to  form  or  to  encrust  stones  of 
other  varieties,  if  they  have  already  formed. 

COMPOSITION    OF    CALCULI. 

Nearly  all  calculi  consist  of  a  nucleus  and  con- 
centric rings  of  crystaline  deposition.  The  nu- 
cleus may  be  of  a  different  composition  from  the 
hulk  of  the  stone;  thus,  it  may  be  of  uric  acid, 
whilst  the  rest  of  the  concoction  is  calsium  ox- 
alate or  prosphates.  Foreign  bodies  wherever 
Lodged  in  the  urinary  passages  will  always  be- 
come surrounded  with  salts  and  will  be  the  nu- 
clei of  stones.  Crystalization  also  occurs  around 
clumps  of  bacteria,  blood  clot,  mucus  and  some- 
times animal  parasites,  hence  at  times  the  stone 
is  hollow  and  without  any  apparent  nucleus.  I 
here  exhibit  a  small  stone  removed  from  the  kid- 
ney by  me,  which  appears  to  be  hollow  and  with- 
out a  nucleus.  Uric  acid  and  oxalate  of  lime  cal- 
culi form  in  acid  urine,  whilst  those  of  the  phos- 
phates are  found  in  an  alkaline  urine. 

Uric  acid  calculi  are  densely  hard,  smooth  or 
slightly  rough  and  yellowish  or  brownish  in  color; 
oxalate  of  calcium  stones  are  known  by  their  very 
rough  or  tuberculated  appearance,  hence  are  called 
"mulberry''  calculi  from  their  supposed  resem- 
blance to  a  mulberry.  They  are  also  very  hard, 
Phosphatic  calculi  are  generally  soft,  friable  and 
white  and  are  found  associated  with  an  alkaline 
urine. 

The  calculi  may  be  located  either  in  the  kidney, 
ureter  or  bladder,  but  the  majority  of  them  have 
been  formed  primarily  in  the  kidney  and  have 
passed  downwards  and  lodged  in  the  ureter  or 
bladder.  Renal  calculi  vary  in  shape,  size  and 
consistence  and  may  be  single  or  multiple.  They 
may    be    smooth    or    rough;    frequently    they    are 


branched  like  coral,  and  often  assume  the  shape 
of  the  renal  pelvis,  with  branches  projecting  into 
the  infundibule  calyces.  1  here  exhibit  a  large 
stone  shaped  like  the  pelvis  of  the  kidney,  with 
those  smaller  concretions  that  I  removed  from  a 
woman  some  years  ago.  Kidney  stones  are  usually 
small  or  of  moderate  size,  but  sometimes  they  as- 
sume large  proportions,  and  instances  are  record- 
ed where  they  have  weighed  as  much  as  19  ounces. 
As  these  calculi  usually  are  of  the  uric  acid  or 
calsium  oxalate  variety,  they  are  hard  and  rough 
and  do  damage  to  the  renal  structure.  When 
infection  has  occurred  and  a  phosphatic  deposition 
has  taken  place,  the  stone  may  be  soft  and  friable. 
The  stone  may  he  single,  or  there  may  be  a  great 
number  of  them  ;  often  one  will  be  found  in  each 
calyx. 

I  wish  at  this  point  to  revert  to  the  anatomy 
of  the  kidney,  which  is  incorrectly  described  in 
many  text-books.  In  most  cases  the  calyces  do 
not  empty  into  the  pelvis  of  the  kidney  directly, 
but  into  upper  and  lower  infundibula,  or  long, 
narrow  channels  which  unite  to  form  the  pelvis 
outside  the  sinus  of  the  kidney,  hence  there  may 
be  calculi  in  each  calyx  or  infundibulum,  possibly 
not  in  the  pelvis  at  all.  When  the  pelvis  becomes 
distended  it  may  form  a  large  cavity  within  the 
kidney  and  may  be  the  seat  of  a  large  stone  or 
stones.  One  or  both  kidneys  may  be  the  seat  of 
calculus,  and  if  one  is  involved  the  other  kidney 
is  also  very  liable  to  become  involved.  It  is  prob- 
able that  the  disease  is  bilateral  in  from  13  to  15 
per  cent,  of  all  cases. 

GEOGRAPHICAL   DISTRIBUTION. 

Whilst  urinary  calculus  is  sufficiently  common 
in  most  parts  of  the  world,  it  is  much  more  fre- 
quent in  some  countries  than  in  others.  It  is 
of  especial  frequency  in  India,  China  and  Egypt, 
and  surgeons  practicing  in  those  regions  acquire 
enormous  experience  in  the  treatment  of  this  dis- 
order. It  is  more  common  in  some  portions  of  a 
country  than  in  other  parts  of  the  same  country, 
and  different  races  living  in  the  same  region  differ 
in  their  susceptibility  to  the  disease.  In  this  part 
of  the  United  States  it  occurs  not  rarely,  but  not 


THE  HOSPITAL  BULLETIN 


87 


so  frequently  as  in  some  other  parts,  and  it  is  less 
frequent  in  the  negro  than  in  the  white  race. 
Why  it  forms  at  all,  and  why  it  occurs  more  fre- 
quently  in  one  locality  than  in  another,  is  a  mat- 
ter of  surmise,  but  not  of  demonstration. 

PATHOLOGY. 

A  calculus  in  the  kidney  is  bound  to  set  up 
more  or  less  nephritis,  if  the  stone  is  fixed  and 
does  not  change  its  position  then  irritation  and 
inflammation  will  be  less  than  if  it  is  movable. 
K  the  kidney  remains  aseptic,  there  may  be  but 
little  pathological  damage  to  the  organ,  but  when 
infection  occurs,  as  it  usually  does,  either  from 
the  blood  stream  or  by  retrogression  from  the 
bladder,  pyelo-nephritis  and  pyo-nephrosis  are  the 
natural  consequences,  and  destruction  of  the  or- 
gan and  loss  of  life  are  by  no  means  uncommon 
sequences. 

SYMPTOMS. 

In  the  absence  of  infection  a  calculus  may  re- 
main latent,  and  give  rise  to  no  symptoms,  or 
to  but  slight  and  vague  uneasiness.  Generally, 
however,  irritation  and  inflammation  of  the  kid- 
ney will  take  place  to  a  sufficient  degree  to  call 
attention  to  the  fact  that  some  pathological  pro- 
cess is  in  operation  and  to  suggest  the  suspicion 
that  it  may  be  the  result  of  nephrolithiasis. 

The  kidney  is  only  palpable,  unless  it  has  be- 
come distended  and  displaced  from  pyonephrosis, 
hence  we  but  seldom  can  feel  this  organ.  In 
some  cases  of  very  large  calculus,  the  kidney  may 
be  felt. 

Pain  is  the  symptom  which  is  most  constant 
and  which  first  attracts  the  attention  of  the  pa- 
tient to  his  disorder.  This  pain  is  a  variable 
symptom,  since  it  may  be  slight  if  the  stone  is 
fixed,  whilst  it  may  be  very  noticeable  if  the  con- 
cretion is  movable  and  readily  changes  its  posi- 
tion in  the  pelvis  of  the  kidney-  The  pain  may 
ladiate  downward  along  the  course  of  the  ureter, 
when  small  particles  gain  entrance  into  this  tube 
and  cause  nephritic  colic,  but  generally  the  pain 
is  an  ache  in  the  kidney  itself,  which  may  he 
intensified  by  pressure  on  this  organ  as  well  as 
by  exercise  or  any  jolting.  Blood  in  the  urine 
can  usually  be  found  in  cases  of  renal  calculus, 
either  in  sufficient  quantity  to  cause  a  distinct 
coloration  of  the  urine,  or  by  a  microscopic  ex- 
amination.     The   hemorrhage  is  seldom  marked, 


as  it  sometimes  is  in  tuberculosis  and  malignant 
conditions  of  the  kidney.  Pyuria  is  absent  in 
those  cases  in  which  infection  has  not  occurred, 
whilst  it  is  very  evident  when  pyelo-nephritis  and 
pyo-nephrosis  have  developed.  In  all  cases  there 
will  be  some  increase  in  the  white  blood  cells  as 
seen  under  the  miscroscope.  Vesical  irritability 
is  a  frequent  sign  of  renal  calculus,  and  often 
the  bladder  symptoms  predominate  over  those  ref- 
erable to  the  kidney.  Increased  frequency  of 
micturition  with  pain  may  be  the  most  evident 
symptoms.  If  the  urine  is  acid,  and  contains 
blood  or  pus,  even  though  the  symptoms  are  such 
as  to  call  attention  to  the  bladder,  it  is  probable 
that  the  trouble  is  located  in  the  upper,  rather 
than  in  the  lower,  urinary  tract.  Anuria  may 
in  rare  cases  occur,  either  from  a  blocking  of 
both  ureters  by  calculii,  or  by  reflex  action.  I  have 
a  small  concretion  which  caused  reflex  anuria, 
and  gave  one  much  anxiety  until  it  passed,  when 
the  urinary  flow  was  promptly  re-established. 
The  passage  of  concretions  will  of  course  serve 
to  direct  attention  to  the  kidney,  but  these  are 
not  often  present  in  the  urine.  Digestive  dis- 
turbances are  often  associated  with  nephrolith- 
iasis, such  as  nausea,  vomiting  and  impaired  di- 
gestion. 

The  symptoms  already  mentioned  are  not  suffi- 
ciently characteristic  to  warrant  a  positive  diag- 
nosis of  calculus,  as  they  may  be  caused  by  very 
diverse  conditions,  but  they  are  highly  sugges- 
tive. We  have,  however,  at  our  command  other 
methods  of  investigation,  from  which  very  posi- 
tive information  may  at  times  be  derived.  The 
most  important  and  valuable  means  of  diagnosis 
possessed  by  us  at  this  time  is  the  radiograph, 
which  when  showing  a  positive  shadow  is  diag- 
nostic in  the  highest  degree,  but  the  absence  of 
a  shadow  does  not  indicate  certainly  that  a  stone 
is  not  present;  neither  does  the  presence  of  a 
shadow  indicate  unerringly  that  a  stone  is  pres- 
ent. 

When  symptoms  of  irritation  of  the  bladder 
do  occur,  especially  when  associated  with  acid 
urine,  a  eystoscopic  examination  should  be  made, 
and  if  the  bladder  walls  appear  to  be  healthy, 
with  perhaps  a  redness  and  pouting  of  one  or 
both  ureteral  orifices,  the  trouble  is  higher  up 
in  the  urinary  tract.  Catherization  of  the  ureters 
will  also  give  valuable  aid  in  determining  the 
nature    and    location    of    the   trouble.      At   times 


88 


THE  HOSPITAL  BULLETIN 


the  introduction  of  a  wax-tipped  ureteral  bougie 
will  indicate  the  presence  of  a  stone  in  the  pel- 
vis (if  the  kidney  or  ureter,  by  means  of  the 
scratches  that  may  be  found  on  the  polished  sur- 
face of  the  bougie. 

Prom  what  has  been  said  it  is  evident  that 
the  symptoms  of  nephritic  calculus  are.  in  most 
instances,  not  diagnostic,  and  it  is  only  by  a 
careful  examination  of  their  phenomena  that 
an  approximately  correct  interpretation  of  their 
meaning   may  be  obtained. 

TREATMENT. 

When  a  calculus  has  formed  in  the  kidney,  there 
is  no  known  means  for  its  removal,  except  by  a 
surgical  operation.  The  administration  of  drugs 
may  at  times  alleviate  the  symptoms,  but  the 
stone  remains.  It  is  necessary  therefore  to  ex- 
pose the  kidney,  incise  its  cortex,  and  remove 
the  concretion,  or  in  some  cases  it  may  be  more 
convenient  to  open  the  pelvis  of  the  kidney  and 
extract  the  stone  through  this  incision.  Ordi- 
narily it  is  better  to  make  the  incision  through 
the  vascular  kidney,  as  healing  is  more  certain 
and  rapid  than  when  the  pelvis  is  incised.  As 
a  rule,  it  is  better  and  safer  to  employ  the  lum- 
bar route,  though  sometimes  it  will  be  neces- 
sary to  reach  the  kidney  by  a  transperitoneal  op- 
eration. Usually  the  incision  is  placed  in  the 
loin,  either  in  an  oblique  or  perpendicular  direc- 
tion, the  muscles  are  divided  or  a  separation  of 
their  fibres  made  by  blunt  dissection,  the  pos- 
terior lamella  of  aponeurosis  divided  ami  the  peri- 
nephric fat  exposed  and  pushed  aside,  when  the 
kidney  is  exposed  to  view.  This  is  separated 
from  its  connections  and  forced  into  the  wound 
or  it  may  lie  brought  out  upon  the  back  of  the 
patient.  The  renal  vessels  are  grasped  with  the 
fingers  or  a  padded  forceps,  to  prevent  hemor- 
rhage, and  an  opening  made  through  the  kid- 
ney substance  and  the  stone  or  stones  grasped 
in  forceps  and  removed.  Sometimes  it  may  be 
necessary  to  crush  the  stone,  before  it  can  be  re- 
moved from  its  bed.  Any  small  fragments  may 
be  removed  by  irrigation.  If  the  kidney  is  in- 
fected, drainage  by  means  of  tube  and  gauze  must 
be  employed ;  if  it  is  not  infected  sutures  of  cat- 
gut are  passed  entirely  through  the  organ  and 
the  wound  in  the  kidney  closed.  The  external 
incision  is  sutured  except  for  a  space  large  enough 
to  permit  the  placing  of  a  small  drain  down  to 
the  kidney.  Rapid  healing  generally  ensues,  with 
relief  of  the  distressing  symptoms. 


REPORT   OF  A   CASE   OF  UNDESCENDED 

TESTICLE   OF   THE   PERINEAL 

VARIETY. 

By  J.  Ernest  Dowdy,  '09, 

Senior  Medical  Student. 

Before  reporting  this  case,  we  may  refresh  our 
memory  regarding  the  steps  in  the  descent  of 
a  normal  testicle. 

The  testicles  are  developed  from  the  genital 
ridge  of  the  Wolffian  body.  The  Wolffian  duct 
becoming  the  vas.  The  testes  in  early  intra- 
uterine life  lie  extra-peritoneal  and  just  below 
and  in  front  of  the  kidneys. 

In  their  normal  descent  they  pass  into  the  in- 
guinal canal  during  the  seventh  month  id'  ges- 
tation and  into  the  scrotum  during  the  eighth 
mouth. 

They  may  be  arrested  at  any  point  in  their 
descent  or  may  take  an  aberrant  direction  and 
be  found  lodged  under  the  skin  of  the  abdominal 
wall,  the  thigh  or  perineum.  One  or  both  tes- 
ticles may  fail  to  follow  the  normal  course  and 
may  lie  retained,  in  the  abdomen,  or  in  the  in- 
guinal canal.  The  causes  which  operate  to  pre- 
vent this  normal  descent  of  the  testicles  are  ob- 
scure. It  may  be  accounted  for,  however,  by  as- 
suming that  the  external  ring  is  of  too  small  a 
size  to  allow  the  testicle  to  pass  through  it.  or 
that  the  vessels  accompanying  the  spermatic  cord 
are  too  short  to  allow  the  cord  itself  to  be 
stretched  sufficiently  to  allow  the  testes  to  reach 
the  bottom  of  the  scrotum. 

The  wearing  of  a  truss  on  account  of  a  hernia 
in  cases  where  the  descent  of  the  testicle  has 
been  delayed  after  birth  may  also  prevent  the 
testes  from  arriving  at  its  normal  place  in  the 
scrotum. 

The  causes  of  cruro  femoral  and  perineal  ectopy 
arc  still  more  obscure.  It  is  -thought,  however, 
that  an  over  development  of  certain  bands  of  the 
gabernaculum  will  have  the  effect  of  drawing  the 
testes  to  one  side  and  thus  occasion  the  aberrant 
course.  The  result  of  ectopy  is  impairment  of 
the  growth  and  development  of  the  testis,  so  that 
it  remains  undersized,  but  probably  possesses  the 
] mwer  of  forming  spermatozoa,  unless  the  struc- 
ture is  destroyed  by  attacks  of  inflammation, 
which  are  very  liable  to  occur.  After  the  tes- 
ticle has  been  disorganized  sterility  of  course  fol- 
lows. 


THE  HOSPITAL  BULLETIN 


89 


Bilateral  retention  does  not  interfere  with  de- 
velopment, for  the  subjects  of  this  misfortune 
have  all  the  characteristic  appearance  of  the  male 
sex.  and  in  no  way  differ  from  their  brothers 
(except  they  are  not  capable  of  procreating  their 
species) . 

In  unilateral  retention  there  is  little  to  be 
anxious  about,  for  one  perfect  testicle  will  suffice 
for  the  development  and  procreation  of  their 
species. 

Complicating  maldescended  testes  very  often 
is  hernia,  and  especially  is  this  true  if  the  tes- 
ticle lies  in  the  inguinal  canal,  as  it  may  inter- 
fere with  the  wearing  of  a  truss,  so  that  strangu- 
lation of  the  hernia  is  very  liable  to  occur.  The 
testicle  when  not  lying  protected  by  the  thighs, 
in  the  scrotum,  is  very  liable  to  be  struck  and 
bruised,  and  the  ectopic  testicle  rarely  escapes 
several  attacks  of  traumatic  inflammation.  It 
may  also  be  the  subject  of  gonorrheal  inflamma- 
tion from  extension  of  a  gonorrhea  from  the 
posterior  urethra. 

Malignant  disease  is  very  apt  to  occur  in  ec- 
topic testicles,  and  is  predisposed  by  attacks  of 
inflammation  to  which  the  testicles  in  this  sit- 
uation are  so  liable  when  the  malignant  disease 
does  involve  this  form  of  undiscovered  testicle 
it  almost  invariably  proves  fatal,  death  taking 
place  in  usually  the  short  space  of  one  year.  The 
sarcomatous  variety  of  tumors  is  the  most  com- 
mon. The  perineal  variety  of  maldescended  tes- 
ticle was  first  described  by  Hunter  in  1786  and 
afterwards  by  Curling  in  1811,  the  subject  has 
received  very  little  attention  by  surgical  writers 
however.  Curling  was  the  first  to  give  a  de- 
tailed description  of  the  condition  in  1857,  and 
a  report  of  nine  collected  cases.  He  was  also 
the  first  to  treat  the  condition  by  operation.  The 
patient  was  an  infant  four  weeks  old,  and  the 
results  of  operation  was  unfortunate.  Goodanl. 
in  1857  and  1860,  reported  two  interesting  cases, 
one  in  a  man  56  years  of  age  and  another  22. 
The  first  case  was  originally  an  inguinal  ectopia, 
which  after  the  wearing  of  a  bandage  for  a  con- 
siderable time,  became  perineal,  the  second  was 
cruroscrotal  ectopia. 

Amiandale,  in  1879,  was  the  first  to  report  a 
ease  successfully  treated  by  surgical  interference. 

Monods  Scvillon,  in  1889,  collected  30  cases 
of  perineal  ectopia,  which  number  Weinberger, 
in  1899,  increased  to  65. 


Adding  to  this  the  more  recent  collection  by 
Klein  there  are  81  cases  up  to  date. 

As  to  the  frequency  of  perineal  ectopia  Remies 
and  Marshall  report  only  17  cases  in  1-1,400  re- 
cruits examined  for  miliary  service,  but  not  one 
of  these  is  stated  to  be  perineal. 

Godanl,  in  53  cases  of  ectopia,  found  only 
three  examples  of  perineal  variety. 

McAdam  Ecclos,  in  his  work  on  imperfectly 
descended  testes,  stales  that  out  of  936  instances 
of  imperfect  descent  of  the  testes,  associated  with 
hernia,  only  five  were  found  to  be  perineal  in 
variety.  At  the  Hospital  for  Ruptured  and  Crip- 
pled Children  in  Xew  York  there  have  been  ob- 
served during  the  past  18  years  737  cases  of  un- 
descended testes,  and  of  these  only  15  were  of 
the  perineal  variety. 

As  regards  the  age  of  the  patient  while  the 
disease  is  of  congenital  origin,  the  testes  are  not 
always  found  in  the  perineum  at  birth.  In  cer- 
tain cases  it  is  situated  just  outside  of  the  in- 
guinal ring,  or  has  passed  below  the  pubic  bone 
ami  later  on  reaches  the  perineum  In  a  great 
majority  of  cases   the  condition  is  unilateral. 

Cases  have  been  reported  of  the  condition  be- 
ing  found   in   both  father  and  son. 

The  case  coming  into  the  Genito  Urinary  De- 
partment of  the  University  Dispensary  gave  the 
following  history:  A  young  white  man  17  years 
old,  well  developed  and  healthy  in  appearance, 
but  complaining  of  a  dull  pain  in  his  testicles, 
which  had  been  present  for  past  four  or  five  days, 
and  he  attributed  it  to  an  injury  received  while 
carrying  a  tray  in  a  baker  shop.  On  examina- 
tion the  left  testicle  was  found  normally  de- 
scended into  the  scrotum.  The  right  testicle  could 
he  distinctly  felt  in  the  perineum,  located  about 
an  inch  anterior  to  the  margin  of  the  anus,  and 
half  inch  to  the  right  of  the  median  raphe.  It 
was  freely  movable,  and  was  about  the  size  of 
a  walnut.  The  condition  had  been  present  since 
birth  and  had  caused  him  no  inconvenience  un- 
til receiving  the  injury  a  few  days  before. 

No  other  members  of  his  family  are  suffering 
with  the  same  condition.  His  father  has  had  an 
oblique  inguinal  hernia  since  childhood.  An  op- 
eration  was   advised,   but   the  patient  refused. 


90  THE  HOSPITAL  BULLETIN 

ANNUAL    REPOKT     OF     DEMONSTRATOR         As  a  result  of  the  efforts  of  the  Anatomy  Board 

OF   ANATOMY,   UNIVERSITY  to  curtail  the  number  and  extent  of  autopsies  upon 

OF  MARYLAND.  subjects  destined  to  become  the  property  of  the 

By  J.  W.  Holland,  M.  D.,  Demonstrator.  Board,  the  material  on  the  whole  was  somewhat 

Faculty  of  Physic,   University  of  Maryland:  better   than   in   previous   years.      There   has  been 

I   have   the  honor  to  submit  the  following  re-  fewer  autopsies  and   less  mutilation  by  post-mor- 

port  of  the  laboratory  of  practical   anatomy   for  teul  operations  than  usual. 

the  session   of   1908-1909.  It  was  decided  by  the  Board  at  its  last  annual 
students   engaged  in   laboratory.  meeting,  in   November,   1908,  to  destroy  all  sub- 
Medical —  jects    which    had    been    extensively    mutilated    by 
Second  year 48  post-mortem  operations,  thus  avoiding  the  ex- 
First  year 57  pense   of   embalming   and   storing   such   material. 

Advanced,  Medical 2  It   was   also    decided    to    allow   deduction   of    the 

Post  Graduates,  Medical 8  price  of  all  subjects,  among  those  allotted  to  the 

Second  year  Medical  (Extra  Work) 5  various  medical  colleges  to  be  used  in  1908-1909, 

which  proved  to  be  very  extensively  mutilated  by 

Total  number  of  Medical   Students 120  post-mortem  examination. 

The    supply   of   material    distributed   from    the 

Dental — First  and  Second  year 49  storage  plant  by  the  Anatomy  Board  during  the 

Advanced  Dental 1  session  of  1908-1909  was  ample  for  all  purposes. 

Only   two   fresh    subjects   were    delivered   directly 

Total  number  of  Dental  Students 50  to    the    laboratory    and    these    were    obtained    for 

special  use. 

Total  Medical  and  Dental 170  The  work  ()f  th(?  ^mnA  year  medical  class  was 

failed  to  accomplish  required  work.  very  satisfactory  and  gratifying,  there  being  but 

Medical—  one  faiiure. 

Second  year 1  Qwing  to  &e  limited  capaeitv  of  the  laboratory 

irs    year ag  wgjj  ag  ^e  sma]i  number  of  demonstrators  it 

en  a    is   necessary   that   the   dental   class   completes   its 

_.,„.-,  .,„  work  before  the  first  year  medical  class  can  he- 
Iota!   failures lo        .  ,  .  .       . 

gin  work.     During  the  last  session  it  was  found 

„,-„.'.,  impossible  to  have  the  first  year  medical  class  be- 

JV1 A 1  sit  K 1 A  J-j . 

-r,      .     ,   ,     .       1(mQ  10„Q  ,Q  gin  work  before  February  15th,   and  though  the 

Received  during  1908-1909 48  ,.-,-,. 

•c  a,  class  continued  dissecting  till  the  close  of  lectures, 

JBrom  Storage —  ° 

Whole   subjects  48  *nere  was  no*  enougn  time  to  accomplish  as  much 

Cut  subjects  12  as  should  be  expected  of  this  class. 

Received  Fresh — Whole  subjects 2  One   result   of   this    abridgement   of    first   year 

Left  from  Session  of  1907-1908 11  work  is  to  crowd  the  second  year  laboratory  work. 

The  whole  session  is  now  required  in  the  second 

Total  73  year  to  complete  the  course. 

It  is  gratifying  to  note  that  eight  post  graduate 

Distributed  during   1908-1909—  0+,,a„,+a  ™™     °        i    ■  ,  -    ,         . 

™    ,.-  -..    ,  o,,    -,  ™  students  were  engaged  m  practical  anatomy  dur- 

To  Medical  Students 29  .       ,,  .  °  ,  ,    ,  , 

m     _,     ,  ,  „ ,    ,  -, .-,  m&  tne  session,    i  lve  second  year  students  demon- 

To  Dental  Students 12  .   n  ,  , ,  ,   ,       , 

„       ,  n        •    i  o  a  strafed   commendable  zeal   by   devoting  their   en- 

For  demonstrations  in  Practical  Surgery.  b       .  .  J  b 

To  Professor   of   Anatomy 2  llre  Cllristmas  vacatlon  *>  extra  laboratory  work. 

To  Post  Graduate  Students 6  Nineteen  complete  sets  and  many  odd  bones  were 

Unfit  for  use 7  PrePare(l   during  the  session.     These   have  been 

Left  from  1908-1909 11  added  to  the  museum,  where  needed,  and  the  bal- 

ance  stored  for  use  of  students  during  the  next 

Total  73  session. 


THE  HOSPITAL  BULLETIN 


91 


THE  HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

EDITED   BY 

A    COMMITTEE    OF    THE    HOSPITAL   STAFF 


PUBLISHED   BY   THE 

HOSPITAL  BULLETIN  COMPANY 
University  of  Maryland 


Business  Address Baltimore,  Md. 

Editorial  Address,     ....        University  of  Maryland 

Baltimore,  Md.,  July  15,  1909 

CHANGES  IN  THE  FACULTY  OF  PHYSIC. 

In  consequence  of  the  resignation  of  Prof.  S.  C. 
Chew  from  the  Faculty  of  Physic  it  has  become 
necessary  for  the  Faculty  to  make  the  following 
changes  in  its  body : 

Prof.  C.  W.  Mitchell  has  been  elected  to  the 
chair  of  Professor  of  Medicine  and  Diseases  of 
Children,  thus  consolidating  the  two  chairs. 

Prof.  Mitchell  graduated  in  the  class  of  1881 
and  has  been  closely  associated  with  the  educa- 
tional work  of  the  University  since  his  graduation. 
In  1896  he  entered  the  Faculty  and  Board  of 
Pegents  as  Prof,  of  Therapeutics,  Diseases  of  Chil- 
dren and  Clinical  Medicine.  He  served  as  Dean 
of  the  Faculty  for  several  years.  Prof.  Mitchell 
has  been  regarded  by  his  colleagues  and  by  the 
student  body  as  an  able,  industrious  and  popular 
teacher.  His  loyalty  and  devotion  to  the  Uni- 
versity of  Maryland  have  been  tested  on  many 
occasions  and  never  found  wanting.  As  a  teacher 
he  has  made  good  on  all  occasions.  In  character, 
scholarship  and  attainments  he  is  a  worthy  suc- 
cessor of  Nathaniel  Potter,  Elisha  Bartlett.  Wm. 
Powers,  Samuel  Chew,  Richard  McSherry  and 
Samuel  C.  Chew,  the  distinguished  men  who  have 
tilled  the  chair  of  medicine  from  the  organization 
of  the  University  to  the  present  time. 

Prof.  Arthur  M.  Shipley  has  been  elected  a 
member  of  the  Board  of  Regents  as  Professor  of 
Therapeutics  and  Surgical  Pathology. 

Prof.  Shipley  graduated  in  the  class  of  1902 
with  the  highest  honors  of  his  class.  For  some 
four  years  he  was  Medical  Superintendent  of  Uni- 
versity Hospital,  where  his  work  was  marked  for 
its  thoroughness  and  ability. 

Among  the  younger  graduates  of  the  University 
Prof.  Shipley  stands  out  as  a  man  of  distinguished 
promise  and  of  rapid  advancement.  He  combines 
all  the  elements  of  the  teacher,  clinician  and  scien- 
tific worker. 


Prof.  Harry  Adler,  of  the  class  of  1895,  has  been 
elected  Professor  of  Clinical  Medicine  and  Direc- 
tor of  the  Clinical  Laboratory.  After  graduation 
Prof.  Adler  spent  several  years  in  post-graduate 
study  in  Europe.  Since  his  return  he  has  been 
associated  with  the  educational  work  of  the  Uni- 
versity, in  which  he  has  shown  splendid  qualifica- 
tions as  a  teacher  and  scientific  worker. 

As  President  of  the  Hebrew  Hospital  he  has 
made  a  high  distinction  as  an  organizer  and  ad- 
ministrator, having  brought  this  institution  into 
the  front  rank  of  our  city  hospitals.  Prof.  Adler 
has  a  wide  field  for  the  development  of  his  talents 
in  the  clinical  work  of  the  University. 

Prof.  I.  J.  Spear,  class  of  1900,  has  been  made 
Clinical  Professor  of  Nervous  and  Mental  Diseases. 
After  two  years  of  work  in  Europe  Prof.  Spear 
took  up  this  line  of  work  at  the  University.  He 
has  made  such  progress  as  a  teacher  that  his  ad- 
vancement was  easily  won.  Prof.  Spear  has  a 
d'stinsruished  career  ahead  of  him. 


OUR   MEDICAL  LIBRARY. 

At  the  present  writing  there  are  more  than  nine 
thousand  bound  volumes  upon  the  shelves  due 
principally  to  the  endeavors  of  Dr.  Eugene  F. 
Cordell,  who,  when  he  assumed  control  some  five 
or  more  years  back,  found  a  nucleus  of  about  four 
thousand  volumes  uncatalogued  and  uncarcd  for. 
By  the  assiduity  and  attention  of  the  librarian 
more  than  five  thousand  volumes  have  been  added 
to  the  collection,  so  that  now  this  library  is  the 
second  medical  library  in  size  in  Baltimore,  and 
contains  many  rare  old  volumes  bequeathed  by 
the  worthies  of  the  years  gone  by.  More  than 
sixty  current  medical  journals  are  upon  the  tables 
of  the  library,  which  is  open  to  our  students, 
alumni  and  members  of  the  faculties.  It  is  housed 
in  Davidge  Hall  in  a  large,  well-lighted  room. 
Anybody  who  wishes  to  do  something  for  the 
University  can  materially  assist  by  either  giving 
or  bequeathing  their  library  to  the  University. 
He  may  rest  assured  that  any  books  donated  will 
be  well  cared  for,  protected,  and  accomplish  a 
great  amount  of  good.  Here  is  an  opportunity 
to  do  something  for  the  University,  occasionally 
donate  a  modern  book  or  two;  place  in  the  hands 
of  the  students  the  best  literature  of  the  day,  and 
you  may  well  feel  assured  that  you  have  done 
something  for  your  fellow  man. 


92 


THE  HOSPITAL  BULLETIN 


MEDICAL  ETHICS. 

In  the  present  issue  of  The  Bulletin  will  be 
found  a  scholarly  paper  on  "Medical  Ethics,"  by 
Prof.  S.  C.  Chew. 

The  Bulletin  knows  of  no  one  who  can  write 
upon  this  subject  with  more  authority  than  Pro- 
fessor Chew.  During  a  long  and  active  profes- 
sional life  he  has  observed  the  highest  standard 
of  professional  conduct  in  all  of  his  relations  to- 
ward his  profession  and  towards  the  public,  and 
has  exercised  an  influence  for  the  uplift  of  pro- 
fessional education  and  practice  which  few  men 
have  enjoyed.  Professor  Chew  has  always  stood 
for  the  highest  ideals  and  aims  of  professional 
work  and  now  at  the  close  of  an  active  and  most 
honorable  professional  career  it  is  most  fitting 
that  he  should  give  to  his  professional  brethren 
his  views  on  medical  ethics.  In  treating  this  sub- 
ject he  has  presented  the  fundamental  principles 
which  should  govern  the  practitioner  in  his  re- 
lations towards  his  profession  and  towards  the 
public.  He  has  said  in  terse  language  all  that 
can  be  said  upon  this  subject,  leaving  the  details 
of  professional  conduct  to  the  good  sense,  to  the 
morals  and  to  the  conscience  of  each  individual 
practitioner. 

In  closing  with  the  inspired  words — "All  things 
whatsoever  ye  would  that  men  should  do  to  you, 
dc  ye  even  so  to  them,"  he  has  expressed  the 
highest  type  of  human  conduct  ever  given  to  man. 

Long  before  the  dawn  of  Christianity  Buddha, 
in  the  East,  preached  the  substance  of  these  teach- 
ings to  his  followers,  but  it  remained  for  the  lowly 
Nazarene  to  give  them  a  force  and  moral  influence 
which  have  kindled  in  the  hearts  of  men  a  love 
and  respect  for  the  grandest  of  all  ethical  prin- 
ciples. 

In  ancient  Greece,  the  Stoics,  Academics,  Para- 
patetics  and  Epicureans  gave  to  their  followers  sys- 
tems of  philosophy  which  sought  to  establish  the 
highest  principles  of  conduct  and  to  confer  the 
greatest  degree  of  happiness  upon  mankind. 

Pythagoras,  Socrates,  Plato  and  Aristotle  gave 
an  impulse  and  moral  force  to  the  teachings  of 
their  respective  sects,  which  have  had  wide  and 
commanding  influence  over  the  intellectual  and 
philosophical  culture  of  succeeding  generations. 
Their  principles  of  ethics  seem  to  lack  only  one 
essentia]  idea.  The  principles  of  human  love  and 
brotherhood  were  smothered  under  the  cloak  of  a 
moral   and   intellectual   culture   which   made  hap- 


piness the  aim  of  conduct  and  duty  an  open 
question  for  discovery.  Cicero,  in  his  Treatise, 
De  Oflieiis,  addressed  to  his  son  Marcus,  sums  up 
tlie  moral  duties  of  mankind  in  a  discourse  of 
remarkable  intelligence  and  philosophical  grand- 
eur. His  ethical  teachings,  largely  borrowed  from 
the  writings  of  Panaetius,  are  so  wise  and  clever 
that  modern  philosophy  has  scarcely  improved 
them. 

To  quote  his  language,  we  have  the  true  ethi- 
cal spirit  which  runs  through  all  his  writings. 
"For  while  many  subjects  in  philosophy,  of  great 
insight  and  utility,  have  been  accurately  and 
copiously  discussed  by  philosophers,  the  most  ex- 
tensive sc<  ms  to  be  what  they  have  delivered  and 
enjoined  concerning  the  duties  of  mankind;  for 
there  can  be  no  state  of  life,  amid  public  or  pri- 
vate affairs,  abroad  or  at  home — whether  you 
transact  anything  with  yourself  or  contract  any- 
thing with  others — that  is  without  its  obligations. 
In  the  due  discharge  of  that  consists  all  the  dig- 
nity, and   in   its  neglect,  all  the  disgrace  of  life." 

Where  can  one  (ind  rules  of  conduct  in  closer 
harmony  with  the  golden  rule  than  is  here  stated? 

Of  the  more  modern  teachers  of  philosophy, 
Dr.  Samuel  Johnson,  in  Rambler,  gives  expression 
to  the  following  thoughts  which  are  so  nearly 
related  to  the  highest  ethical  teachings  that  they 
should  he  considered  by  all  who  aim  at  excel- 
lence in  life's  great  work. 

"It  must  be  strongly  impressed  upon  our  minds 
that  virtue  is  not  to  he  presumed  as  one  of  the 
means  to  fame,  but  fame  to  be  accepted  as  the 
only  recompense  which  moralists  can  bestow  on 
virtue — to  be  accepted  with  complacency,  but  not 
sought  with  eagerness.  The  true  satisfaction  which 
is  to  be  drawn  from  the  consciousness  that  we  shall 
share  the  attention  of  future  times,  must  arise 
from  the  hope  that  with  our  name  our  virtues 
will  be  propagated  and  that  those  whom  we  can 
not  benefit  in  our  lives  may  receive  instruction 
from  our  examples  and  incitement  from  our  re- 
nown." 

The  Bulletin  voices,  it  believes,  the  wishes 
of  its  readers  when  it  expresses  the  hope  that 
Professor  Chew,  in  the  evening  of  a  well-spent 
life,  in  the  enjoyment  of  a  quiet  home,  in  his 
library  filled  with  the  world's  best  literature,  will 
find  ample  lime  and  inclination  to  prepare  a 
series  of  articles  upon  ethical  and  literary  sub- 
jects for  the  firofession. 


THE  HOSPITAL  BULLETIN 


93 


ITEMS. 

The  last  meeting  of  the  Dorchester  County 
Medical  Society  held  in  Cambridge  with  Dr.  E. 
Eakin  Wolff,  class  of  1809,  in  the  chair,  was  ad- 
dressed by  Dr.  C.  W.  Mitchell.  Dr.  H.  V.  Har- 
baughj  class  of  1907,  was  admitted  to  member- 
ship, and  upon  the  motion  of  Dr.  Guy  Steele,  Dr. 
C.   W.    Mitchell   to    honorary   membership. 


Dr.  Salvatore  Deniarco  has  returned  from  East 
Orange,  N.  J.,  where  he  was  called  to  operate 
upon  a  case  of  appendicitis. 


Doctor  and  Mrs.  Gordon  Wilson  have  returned 
from  their  honeymoon  and  are  guests  at  the  Chat- 
tolanee. 


Dr.  D.  C.  Absher,  class  of  1909,  who  was  op- 
erated upon  at  the  University  Hospital  recently, 
is  reported  to  be  doing  nicely  and  will  soon  be 
able  to  be  about. 


Dr.  William  F.  Schwartz,  class  of  1908,  for- 
merly resident  physician  to  the  insane  department 
of  Bayview  Asylum,  has  removed  to  1200  North 
Caroline  street. 


Dr.  R.  C.  Bay,  medical  superintendent  of  the 
University  Hospital,  has  been  commissioned  a 
captain  in  the  medical  corps  of  the  Maryland 
National  Guard  and  assigned  to  the  Fifth  In- 
fantry. 


Dr.  Eugene  F.  Cordell  has  returned  to  the  city 
after  a  fortnight  spent  at  Atlantic  City,  where 
he  attended  the  meeting  of  the  American  Medi- 
cal Association. 


Dr.  Frank  J.  Kirby,  class  of  1892,  delivered 
the  principal  address  to  the  graduates  at  the  re- 
cent commencement  of  the  St.  Joseph's  Hospital 
Training  School  for  Nurses. 


Dr.  N.  E.  Berry  Iglehart,  class  of  1889,  of 
Baltimore,  attended  the  sessions  of  the  Ameri- 
can  Medical  Association  at  Atlantic  City. 


Dr.  William  P.  E.  Wyse,  class  of  1886,  and 
Mrs.  Wyse  have  returned  from  a  short  visit  to 
Annapolis. 


Doctor  and  Mrs.   Henry  J.   Berkeley  are  sum- 
mering at  Magnolia,  Mass. 


Dr.   Ernest  Neale  has  closed  his  city  home  and 
will  summer  at  Ocean  City,  Md. 


Miss  Ruth  Kuhn,  has  resigned  the  superintend- 
ency  of  the  Atlantic  Coast  Line  Hospital,  Way- 
cross,  Ga. 


Drs.  Hiram  Woods  and  Charles  O'Donovan  ad- 
dressed a  meeting  at  Centreville,  June  9,  1909, 
held   to  create   interest   in  the  proposed   hospital 

to  be  erected  in  or  near  Centreville. 


Dr.  Charles  W.  Mitchell,  who  has  been  the  guest 
of  President  Woodrow  Wilson  at  his  home  in 
Princeton,    has    returned    to    his   home. 


1  >r.    A.    D.    McConachie   has   been    spending   a 
fortnight  at  Atlantic  City. 


Drs.  L.  Gibbons  Smart,  R.  C.  Massenberg,  J. 
C.  Clarke,  M.  G.  Porter,  James  F.  H.  Gorsuch 
and  J.  H.  Bates,  all  of  Baltimore  county,  attended 
the  last  meeting  of  the  Baltimore  County  Medi- 
cal Society  held  at  Towson.  Dr.  J.  Clement 
Clarke,  superintendent  of  Springfield  Asylum,  at 
Sykesville,  Md.,  invited  the  Society  to  hold  their 
duly  meeting  at  his  Hospital. 


Miss  Ann  Elizabeth  Chapman,  a  graduate  of 
the  University  Hospital  Training  School  for 
Nurses  and  for  several  years  after  graduation  in 
charge  of  the  operating  rooms  at  the  University 
Hospital,  at  present  superintendent  of  the  Emer- 
gency Hospital,  Easton,  Md.,  has  been  notified 
by  the  Federal  authorities  that  she  passed  second 
in  the  competitive  examinations  for  trained  nurses 
for  service  in  Panama,  held  throughout  the  coun- 
try in  the  spring,  and  has  been  asked  to  inform 
them  of  the  earliest  date  at  which  she  can  report 
in  New  York  to  be  sent  to  the  Ancon  Hospital, 
on  the  Pacific  Slope  of  the  Panama  Canal  Zone. 
Miss  Chapman  graduated  with  the  class  of  1906. 
Miss  Mary  Hamlin,  another  of  our  graduates,  has 
been  successful  in  an  examination  for  nurses  for 
service  in  the  naval  branch  of  our  military  or- 
ganization. 


94 


THE  HOSPITAL  BULLETIN 


Our  alumni  hold  the  following  positions  at  the 
College   of   Physicians   and   Surgeons,   Baltimore : 

Professor  of  Principles  and  Practice  of  Sur- 
gery, Clinical  and  Genito-Urinary  Surgery,  and 
Dean  of  the  Faculty — Dr.  Charles  F.  Be  van. 

Professor  of  Medical  Jurisprudence  and  Di- 
rector of  the  Pasteur  Institute — Dr.  N.  G.  Keirle. 

Professor  of  Obstetrics  ami  Gynecology — Dr. 
George  W.   Dobbin. 

Professor  of  Pathology  and  Bacteriology — Dr. 
W.    Royal   Stokes. 

Professor  of  Anatomy  and  Clinical  Surgery — 
Dr.  A.  C.  Harrison. 

Professor  of  Clinical  Medicine — Dr.  Cary  B. 
Gamble,  Jr. 


Dr.  Eugene  Lee  Crutehfield,  fellow  and  gold- 
medalist  of  the  Society  of  Science,  Letters  and 
Art,  of  London,  England,  has  been  elected  to  a 
fellowship  in  the  American  Academy  of  Medicine. 
This  is  the  most  scholarly  and  exclusive  medical 
organization  in  the   United  States. 


I)]-.  Solomon  L.  Cherry,  class  of  1908,  has  been 
appointed  Pathologist  to  the  Hebrew  Hospital, 
Baltimore;  Drs.  Samuel  H.  Long  and  Everette 
[seman,  assistant  resident  physicians. 


Dr.  J.  S.  Norman  declined  the  appointment 
as  assistant  resident  physician,  Bayview  Asylum, 
and   Dr.   E.   P>.  Wright  received  the  appointment. 


Dr.  Thomas  E.  Satterthwaite,  LL.  D.,  1908, 
of  New  York,  has  been  appointed  by  this  Uni- 
versity a  delegate  to  the  350th  anniversary  of  the 
Foundation  of  the  University  of  Genoa. 


Dr.  E.  W.  Pressly,  class  of  1887,  of  Glover. 
S.  ('.,  has  been  in  poor  health  for  over  two  years. 
Recently  he  experienced  a  slight  paralytic  stroke. 


Dr.  Nathan  YVinslow,  class  of  1901,  has  been 
elected  managing  editor  of  the  Maryland  Medi- 
cal Journal. 


Dr.  E.  G.  Ballenger,  class  of  1901,  is  editor 
of  the  Record  and  Journal  of  Medicine,  published 
at  Atlanta.  Ga. 


at  Salisbury,  Md.,  has  resigned  to  take  charge  of 
the  Lelia  Morton  Memorial  Station,  at  Leesburg, 
Va.  The  Memorial  was  established  at  Leesburg 
by  ex- Vice-President  Levi  P.  Morton  in  memory 
of  his  daughter,  and  since  its  inauguration  five 
years  ago  has  employed  the  services  of  a  trained 
nurse  for  the  benefit  of  the  people  of  Leesburg 
and  vicinity.  Miss  Wise  is  a  daughter  of  Mr. 
William  X.  Wise,  of  Leesburg. 


Dr.  Jacob  Wheeler  Bird,  class  of  1907,  of  West 
River,  Md.,  for  the  past  three  years  connected  with 
the  University  Hospital,  first  as  resident  student, 
then  as  assistant  resident  surgeon  and  during  the 
past  year  with  the  additional  office  of  assistant 
superintendent,  has  located  at  Sandy  Spring,  Md., 
taking  the  place  of  the  late  Dr.  Boger  Brooke, 
also  a  graduate  of  this  school. 


Dr.  Frank  O.  Rogers,  class  of  1901.  spent  Fri- 
day, June  2,  1909,  in  Baltimore.  He  is  the  same 
old  Frank,  as  full  of  fun  as  ever.  He  informs  The 
Bulletin  that  Dr.  Edward  0.  McEachern,  class 
of  1901,  died  recently  of  tuberculosis;  also,  of 
the  death  of  Dr.  William  H.  Whitehead,  of  Rocky 
Mount,  N.  C,  class  of  1870,  father  of  Dr.  Joe 
Whitehead,  class  of  1899,  also  of  the  same  place. 
Amongst  some  of  the  other  news  gleaned  from 
him  were  that  Dr.  Louis  Haines,  class  of  190*2, 
of  Winston-Salem,  N.  C,  has  given  up  medicine 
and  taken  to  the  brick  manufacturing  business; 
that  Dr.  R.  T.  S.  Steele,  class  of  1899,  of  North 
Carolina,  has  forsaken  medicine  and  removed  to 
Pennsylvania,  where  he  has  entered  the  mining 
business. 


Dr.  Murray  Hollyday,  class  of  1908,  formerly 
resident  physician  in  Church  Home  and  Infirm- 
ary, has  been  appointed  resident  physician  to  the 
Maryland   Steele  Company,  Sparrows  Point,  Md. 


Dr.  Gideon  N.  Van  Poole,  class  of  1899,  cap- 
tain United  States  Army  Medical  Corps,  has  been 
relieved  from  duty  at  Fort  Slocum,  X.  Y..  and 
will  proceed  at  the  expiration  of  his  present  leave 
of   absence  to   Fort   Sheridan,    111.,   for   duty. 


Miss   Eelen  Wise,  a  graduate  of  the  University  Dr.   W.    E.   Wiegand    attended   the  meeting  of 

Hospital    Training    School    for    Nurses,    and    su-      the    American    Medical    Association    at    Atlantic 
perintendent   of  the   Peninsula   General   Hospital      City. 


THE  HOSPITAL  BULLETIN 


95 


Dr.  William  T.  Councilman,  class  of  1878,  Pro- 
Eessor  of  Pathology  in  the  Harvard  Medical 
Scl 1,  lias  been  elected  a  trustee  of  the  Ameri- 
can   Medical   Association. 


Dr.  George  Wythe  Cook,  class  of  1869,  of  the 
District  of  Columbia,  has  been  appointed  by  the 
President  of  the  American  Medical  Association  a 
member  of  the  Committee  on  Rules  and  Order 
of  Business,  and  Dr.  George  Lane  Taneyhill,  a 
member  of  the  Reference  Committee  on  Legisla- 
tion and  Political  Action. 


At  the  meeting  of  the  American  Medical  As- 
sociation Dr.  Fry,  of  Washington,  defended  ven- 
tro-suspension,  though  fixation  occasionally  oc- 
curred by  accident.  He  objected  to  the  Alexander 
operation  owing  to  the  difficulty  of  isolating  the 
ligaments.  He  thought  the  Baldy-Webster  op- 
eration the  best  yet  described  as  it  so  completely 
lifted  the  prolapsed  ovary. 


Dr.  Branch  Craig,  class  of  1909,  had  the  honor 
of  attending  the  highest  grade  before  the  recent 
examination  of  the  North  Carolina  State  Medical 
Examining  Board.  The  Bulletin  takes  this  op- 
portunity of  congratulating  and  thanking  Dr. 
Craig  for  the  credit  he  has  reflected  upon  his 
Alma  Mater. 

We  are  also  glad  to  report  that  every  candi- 
date from  the  University  of  Maryland  appearing 
before   this   Board   did  us   the  credit   of   passing. 


A  diploma  of  honor  for  an  exhibit  of  superior 


The  Maryland  Committee  for  the  Prevention 
of  Blindness  has  been  organized  with  our  alumni 
occupying  the  following  offices: 

Vice-Chairman — Dr.  Hiram  Woods. 

Medical  Committee — Louis  Allen,  J.  Whit- 
ridge  Williams,  Hiram  Woods,  Samuel  Theobald, 
Prank  Crouch,  Herbert  Harlan,  Guy  Steele,  L. 
B.  ilenkel.  Jr.,  W.  F.  Hall,  Robert  L.  Randolph, 
R.  Lee  Hall,  H.  0.  Reik,  J.  L.  Lewis,  James  .1. 
Cat  toll,  0.  M.  Linthicum,  Marshall  Price,  G.  I. 
Bat  wick,  H.  W.  McComas,  F.  ().  Miller,  J.  (i. 
Selby  and  P.  S.  Page. 


Dr.  William  X.  Bisphan,  class  of  1897,  now  a 
major  in  the  United  States  Army,  has  been  or- 
dered from  San  Francisco  to  Fort  Leavenworth, 
Kan.,  for  duty  at  the  United  States  Military 
Prison. 


At  the  annual  meeting  of  the  Faculty  of  the 
Maryland  Medical  College  our  alumni  were  elected 
to  the  following  offices: 

President — Dr.  A.  D.  McConachie. 

Vice-President — Dr.  J.  W.  Funck. 

Dean — Dr.  Harry  Gross. 

Assistant  Dean— Dr.  W.  S.  Smith. 


On  invitation  of  the  Nebraska  Pharmaceutical 
Association,  Dr.  Henry  P.  Hynson,  professor  of 
the  practice  of  pharmacy  in  the  department  of 
pharmacy  of  the  University  of  Maryland,  made 
an  address  before  the  Western  organization  at 
their  annual   meeting   beginning  June   15. 


Dr.    W.   J.   Riddick,   acting  assistant   surgeon, 


merit  was  awarded  to  the  University  ot  Maryland  TT    .,    ,  0,  ,,  ,        ,  t       -,   ,  •,  7 

.  ,.      ,.      ,,.        „     ..  ,  *         ,  United  States  Aavy,  has  been  ordered  to  dutv  at 

at    the   Atlantic    Citv    Meeting   ot    the    American  . ,      ,,.      ,  ..    '  "  .    , „      .  ' 

.,  ,.    ,  .  ,.  the  Charleston  Navy  lard.  Charleston,  S.  C. 


Medical  Association. 


Professor    Hiram    Woods    attended    the    recent  Dr"  IL  K  Jenkins,  acting  assistant  surgeon,  has 

meeting    of    the    American    Medical    Association     been  ordered  to  duty  at  the  Naval. Hospital,  Nor- 
held  at  Atlantic  City.  lolk'  ^  a- 


Professor  P.  Tunstall  Taylor  is  spending  a  few         Dr"  Charles  IL  0'D°novan  «  summering 

,,.,  •     -R.--J--,,  country   place,   Wicklow,  near   Catonsville. 

Lays  m  noston.  ■>    r       > 


at   his 


Dr.  William  Royal  Stokes  delivered  an  address  Miss  Nettie  Flannagan,  former  superintendent 

to  the  recent  graduates  of  the  College  of  Physi-  of    nurses,    has    accepted    the    superintendency    of 

cians  and   Surgeons,  Baltimore,  at  their  banquet  nurses,    St.   Luke's   Hospital,    Spokane,   Washing- 

at  the  Hotel  Belvedere.  ton.     She  entered  upon  her  duties  June  1,  1909. 


96 


THE  HOSPITAL  BULLETIN 


Miss  Augusta  Russell,  a  graduate  of  the  Uni- 
versity Hospital  Training  School  for  Nurses,  lias 
resigned  her  position  as  superintendent  of  nurses, 
Maryland  State  Sanatorium  for  Tuberculosis, 
Sahillasville. 


Dr.  Thomas  J.  O'Donnell,  class  of  1903,  a  well- 
known  young  physician  of  South  Baltimore,  has 
been  made  a  police  surgeon  by  the  Board  of  Po- 
lice Commissioners.  He  succeeds  Dr.  Rastus  Ran- 
som Norris,  class  of  1904,  police  physician  for 
the  First  Medical  District.  Dr.  O'Donnell  is  one 
of  the  most  prominent  of  the  young  physicians 
of  South  Baltimore  and  is  widely  known  in  that 
section.  He  is  a  graduate  of  the  medical  depart- 
ment of  the  University  of  Maryland,  and  was  at 
one  time  resident  physician  in  St.  Joseph's  Hos- 
pital. 

Dr.  Norris  has  removed  to  Crisfield,  where  he 
will   engage   in    the   practice   of   his   profession. 


Dr.  Gordon  T.  Simonson,  class  of  1896,  is  lo- 
cated at  Crisfield,  Md.,  where  he  enjoys  a  large 
and    lucrative   practice. 


Dr.  Joseph  W.  Holland,  class  of  1896,  has  been 
advanced  to  the  position  of  Associate  Professor 
of  Anatomy. 

Dr.  Clarence  E.  Collins,  class  of  1902,  is  lo- 
cated at  Crisfield. 


Dr.  W.  II.  Coulbourn,  class  of  1901,  is  Located 

al   Crisfield. 


Dr.   William   D.    Cawley,  class   of   1902,   is   lo- 
cated at  Elkton,  Md. 


Dr.  Albert  Scott  Harden,  class  of  1901,  is  lo- 
cated at  Newark,  N.  J. 


Dr.  Robert  Lee  Hall,  class  of  1901,  is  located 
at   Pocomoke  City,  Md. 


Dr.  Frederick  William  Schlutz,  class  of  1902, 
of  Minneapolis,  has  sailed  for  Europe,  where  he 
will  study  in  the  clinics  of  Germany  and  Vienna. 


Dr.  A.  W.  Dissosway,  class  of  1905,  of  Ply- 
mouth, N.  C,  recently,  while  in  the  city,  paid 
the  hospital  a  hurried  visit.  He  reports  that  he 
i<  doing  nicely. 


Dr.  Ernest  Rowe,  class  of  1906,  has  located  in 
Baltimore,  and  will  devote  his  entire  attention  to 
diseases  of  the  nose,  throat,  eye  and  ear.  During 
the  past  year  he  was  superintendent  of  the  Bal- 
timore Eye,  Ear  and  Throat  Hospital. 


Dr.  John  R.  Winslow  has  resigned  from  the 
staff  of  the  Presbyterian  Eye,  Ear  and  Throat 
Hospital  and  has  accepted  a  position  upon  the 
staff  of  the  Baltimore  Eye,  Ear  and  Throat  Hos- 
pital. 


Amongst  the  many,  many  eulogistic  expressions 
anent  the  resignation  of  Professor  Samuel  ('. 
Chew  from  the  chair  of  medicine  was  the  editorial 
in  the  Baltimore  Sun  of  recent  date,  which  is 
herewith   appended : 

Long  and  Honorable  Career. — The  resigna- 
tion of  Dr.  Samuel  C.  Chew  from  the  chair  of 
the  Practice  of  Medicine  in  the  faculty  of  the 
University  of  Maryland  severs  an  association 
which  has  continued  personally  and  by  heredity 
for  the  greater  part  of  the  life  of  that  venerable 
institution.  In  1907  the  University  celebrated 
its  centennial.  More  than  eighty  years  before  that 
celebration,  when  the  school  of  medicine  was  less 
than  twenty  years  old,  Dr.  Chew's  father,  the 
elder  Dr.  Samuel  Chew,  who  came  up  from  Cal- 
vert county,  entered  as  a  student  of  medicine. 
Fourteen  years  later  he  was  appointed  to  the  chair 
of  Materia  Medica,  and  afterward  succeeded  to 
that  of  the  Practice  of  Medicine,  which  he  oc- 
cupied up  to  the  time  of  his  death  in  1864.  His 
son,  the  present  Dr.  S.  C.  Chew,  then  went  into 
the  faculty — first  as  professor  of  Materia  Medica, 
and  then  to  the  chair  of  the  Practice  of  Medicine, 
which  he  has  just  resigned.  He  has,  therefore, 
been  a  member  of  the  faculty  for  nearly  45  years. 

In  1907  the  University  conferred  upon  him  the 
degree  of  doctor  of  laws,  and  in  presenting  him 
on  that  occasion  Mr.  John  P.  Poe  said  of  him: 
''During  a  professorship  of  43  years  thousands  of 
students  have  had  the  benefit  of  his  luminous  and 
comprehensive  instruction,  and  now,  with  a  mind 
of  great  original  force,  enriched  by  the  valuable 
stores  of  a  wide  and  diversified  experience  and 
strengthened  by  assiduous  cultivation  and  ripe 
scholarship,  he  still  invigorates  the  University  by 
the  fruits  of  his  high  character,  matured  wisdom 
and  unusual  attainments." 

Dr.  Chew  succeeded  Mi-.  S.  Teackle  Wallis  as 
president  of  the  trustees  of  the  Peabody  Institute 


THE  HOSPITAL  BULLETIN 


97 


and  still  occupies  that  important  place.  Few  citi- 
zens of  Baltimore  are  better  known  to  the  people 
of  the  city  in  which  he  has  spent  his  honorable 
and  useful  life,  or  are  more  generally  honored  ami 
beloved  than  Dr.  Chew. 


Dr.  Irving  J.  Spear  has  been  elected  clinical 
professor  of  Diseases  of  the  Nervous  System  and 
Pschiatry. ■ 

President  Thomas  Fell  has  been  notified  by  the 
Army  authorities  that  St.  John's  College,  Depart- 
ment of  Arts  and  Sciences,  has  been  designated 
as  one  of  the  distinguished  military  institutions 
of  the  country,  as  a  consequence  of  which  he 
may  designate  one  of  his  graduates  for  appoint- 
ment as  second  lieutenant  to  the  United  States 
Army.  No  mental  requirements  are  necessary  for 
the  appointee  as  a  perquisite  to  his  commission, 
hut  he  must  pass  the  ordinary  physical  examina- 
tion.   

Dr.  John  C.  Travers,  class  of  1895,  who  left 
America  six  weeks  ago  to  accept  a  government 
position  in  the  Philippines,  writes  concerning  his 
impressions  of  Hawaii,  where  he  stopped  en  route 
to  Yokohama,  Japan,  that  he  was  charmed  with 
the  equable  climate  and  productive  soil  of  Hawaii, 
as  well  as  the  hospitality  of  the  residents  of  Hono- 
lulu. Of  the  climate  he  says:  "The  combination 
of  tropical  sunshine  and  sea  breeze  produces  a 
climate  which  can  be  compared  to  nothing  on  any 
mainland  or  to  any  other  island  group.  Hawaii 
has  a  temperature  which  varies  not  more  than 
ten  degrees  through  the  day,  and  which  changes 
the  year  around  from  55  to  90  degrees.  Swel- 
tering heat  or  biting  cold  are  unknown,  sunstroke 
is  a  mythical  name  or  an  unthought  of  thing.  A 
frost  bite  is  heard  of  no  more  than  a  polar  bear. 
Conjure  up  the  memory  of  the  most  perfect  May 
day,  the  kind  you  are  probably  having  at  home 
at  the  present  time.  A  day  when  sunshine,  soft 
airs  and  the  fragrance  of  buds  and  smiling  Na- 
ture combine  to  make  the  heart  glad.  Multiply 
it  by  365  and  the  result  is  the  climate  of  Hawaii.*' 
He  goes  on  to  say  that  the  fruit  packers  of  Hawaii 
have  made  fortunes,  and  there  is  a  bright  future 
for  those  who  engage  in  the  industry.  Sugar  is 
the  staple  product,  the  treaty  of  reciprocity  ad- 
mitting sugar  free  to  American  markets  having 
resulted  in  so  fostering  the  industry  that  $100,- 
oiiii.OOO  is  now  invested  in  it,  and  still  there  is 
waste  land  awaiting  cultivation.  Doctor  Travers 
practiced  for  many  years  in  South  Baltimore. 


The  University  of  Maryland  Alumni  of  the 
American  Medical  Association  held  their  annual 
meeting  at  the  Wiltshire,  Atlantic  City,  on  Tues- 
day, dune  8,  1909.  In  the  absence  of  the  presi- 
dent. Dr.  Laurence  D.  Gorgas,  of  Chicago,  Dr. 
(',.  Lane  Taneyhill,  of  Baltimore,  vice-president, 
presided.  Dr.  Arthur  Ewens,  of  Atlantic  City, 
welcomed  the  visitors.  The  following  officers 
were  elected : 

President — Dr.  G.  Lane  Taneyhill. 

Vice-President — Dr.  A.  A.  Matthews. 

Secretary — Dr.  G.  B.  M.  Bowen,  Vernol,  Utah. 

Fifty-two  sat  down  to  the  banquet.  Dr.  A. 
D.  McConachie  was  toastmaster.  Speeches  were 
made  by  Drs.  Randolph  Winslow,  J.  S.  Hartman, 
1.    S.   Stone,   etc.     Those  present  were: 

1  toctors — 

Harry  Adler,  1895,  Baltimore. 

Charles   Bayley,  Jr.,   1904,   Baltimore. 

Josiah  S.   Bowen,   1903,  Mt.   'Washington,   Md. 

G.  B.  M.  Bowen,  1887,  Vernol,  Utah. 

Frank   E.   Brown,   1893,  Baltimore. 

T.  Harris  Cannon,   1901,  Baltimore. 

Albert  H.  Carroll,  1907,  Baltimore. 

James  J.  Carroll,  1893,  Baltimore. 

Lee  Cohen,  1895,  Baltimore. 

E.  V.  Copeland,  1905,  Round  Hill,  Va. 

Eugene  F.  Cordell,  1868,  Baltimore. 

G.  Wythe  Cook,  1869,  Washington,  D.  ('. 

James   M.    Craighill,    188'?,    Baltimore. 

Andrew  J.  Crowell.  1893,  Charlotte,  N.  C. 

S.  Thomas  Day,  1889,  Port  Norris,  N.  J. 

Curran  B.  Earle,  1896,  Greenville,  N.  C. 

Arthur   E.   Ewens,   1904,  Atlantic  City,   N.   J. 

Frank    V.    Fowlkis,    1887,   Burkeville,   Va. 

Henry  M.  Fitzhugh,  1897,  Westminster,  Md. 

Monte   Griffith,    1896,   Washington,   D.    C. 

Jos.  E.  Gichner,  1890,  Baltimore. 

Norton  Royce  Hotchkiss,  1891,  New  Haven.  Ct. 

Jacob  H.  Hartman,   1869,  Baltimore. 

Albert  S.  Harden,  1901,  Newark,  N.  J. 

Jos.  L.  Hirsh,  1895,  Baltimore. 

Richard  Hall  Johnston,   1894,  Baltimore. 

Frank  J.  Kirby,  1893,  Baltimore. 

Dorsey  W.  Lewis,  1896,  Middletown,  Del. 

Edgar  B.  LeFevre,  1905,  Inwood,  W.  Va. 

Robert  L.  Mitchell,  1905,  Baltimore. 

Chas.  W.  McElfresh,  1889,  Baltimore. 

Robert  A.  Moore,  1891,  Durham,  N.  C. 

Alexander  D.  McConachie,  1890,  Baltimore. 

H.  E.  McConnell,  1890,  Chester,  S.  C. 

T.  K.  Oates,  1896,  Martinsburg,  W.  Va. 


98 


THE  HOSPITAL  BULLETIN 


J.  N.  Reik.  1900,  Baltimore. 

Chas.  W.  Roberts,  1906,  Douglas,  Ga. 

J.    Dawson    Reeder,    Baltimore. 

W.  II.  William  Ragan,  1874,  Eagerstown,  Md. 

('.  M.  Strong,  1888,  Charlotte,  X.  C. 

Earry  W.  Stoner,  1907,  Baltimore. 

[saac  S.  Stone,  1872,  Washington,  D.  C. 

Frederick  Snyder,  1908,  Rosendale.  X.  Y. 

G.  Lane  Taneyhill,  1865,  Baltimore. 

0.  Tydings,  1877,  Chicago. 

J.  S.  Turner.  1896,  Greensboro,  X.  C. 

Randolph  Winslow,  1873,  Baltimore. 

J.  S.  B.  Woolford,  1896,  Chattanooga.  Tenn. 

Wm.  E.  Wiegert.  1876,  Baltimore. 

E.  A.  Wareham,   1883,  Hagerstown,  Md. 


In  an  oration  on  ""State  Medicine  and  Hy- 
giene." before  the  American  Medical  Association, 
at  Atlantic  City.  June  9,  1909,  Dr.  John  S.  Ful- 
ton, of  Baltimore,  advocated  national  vital  statisti- 
cal laws  and  condemned  the  present  boards  of 
health,  which  wait  for  disease  to  break  out  be- 
fore taking  any  action. 

Dr.  Fulton  also  stated  that  the  United  States 
had  neglected  to  carry  out  its  agreement  with  the 
Italian  Government  to  report  deaths  of  Italians 
in  this  country,  and  blamed  the  failure  on  the 
lack  of  method  of  the  Federal  authorities,  who. 
lie  asserted,  are  behind  the  health  departments  of 
every  other  country  in  the  world. 


At  the  recent  examination  of  the  State  Board 
of  Examiners  of  South  Carolina  the  following 
graduates  of  the  University  of  Maryland  passed 
the  examination: 

(i.  C.  Bolen,  M.  D. 

M.  E.  Brogden.  M.  D. 
I).  A.   Bun-ess,  M.  D. 
W.  T.  Gibson,  M.  D. 
J.  W.   McConnell,  M.   D. 
L.  A.  Risor.  M.  D. 
T.  II.  Wedoinan,  M.  D. 
There  were  no  rejections. 


Dr.  R.  C.  Buck,  class  of  1874,  now  practicing 
his  profession  at  Garrisonville,  Stafford  county. 
A  a.,  sent  Tin:  Bullf.tix  the  following  Program 
of  Graduation  of  his  class.  It  will  no  doubt  be 
lead  with  interest  by  the  older  alumni  of  the  Uni- 
versity. ( >f  the  class  numbering  17  at  time  of  grad- 
uation  eighteen  are  known  to  be  dead.  Of  the 
Faculty  of  Physic  only  two  survive — Prof.  S.  C. 
Chew  and  Professor  Tiffany,  and  they  are  not 
actively  connected  with  the  present  Faculty.  The 
Hon.  S.  Teackle  Wallis.  Provost,  and  the  Rev. 
Moses  D.  Hoge,  the  orator  of  the  occasion,  are 
dead. 

Sixty-seventh  commencement  of  the  School  of 
Medicine  of  the  University  of  Maryland,  held  at 
Ford's  Xew  Opera  House,  Baltimore,  Tuesday. 
March  3rd.  1871. 

President  of  the  class.  W.  R.  Winchester. 

Committees. — Stage  Committee  (White  Badge). 
— Louis  A.  Weigel,  Chairman:  James  Brown,  H. 
T  Burgin.  W.  C.  Claude,  G.  A.  Fenton,  J.  B. 
Galloway,  Gabriel  Gimenez,  W.  B.  O'Reilly. — 
Orchestra  Committee  (Blue  Badge). — C.  E.  Cham- 
berlayne.  Chairman:  W.  B.  Beach,  J.  H.  Cram, 
.1  (t.  Harrington,  C.  L.  Mitchell,  R.  H.  Smith,  B. 
F  Winchester,  R.  E.  Yoe. — Balcony  Committee 
(Blue  and  White  Badge).— F.  D.  Emack,  Chair- 
man; Charles  Abert,  Jr.,  J.  D.  Fiske,  E.  P.  Mc- 
Devitt.  T.  E.  Murrell,  William  Eawlings,  X.  C. 
Stephens,  L.  L.  W.  Tall. 

Order  of  Exercises. — Reading  of  the  mandamus, 
by  the  Dean.  Conferring  of  Degrees,  by  Hon.  S. 
Teackle  Wallis,  LL.  D.,  Provost  of  the  University. 
Valedictory  Address,  by  Rev.  Moses  D.  Hoge. 

Graduates,  1871. — Howard  E.  Ames,  Maryland  : 
Joseph  S.  Baldwin,  Virginia :  Martin  B.  Billings- 
ka.  Maryland:  John  C.  Bryce,  South  Carolina: 
Carey  Buck,  Virginia:  Charles  T.  V.  S.  Butler, 
West  Virginia:  M.  S.  Butler,  West  Virginia;  C.  F. 
Cairnes,  Maryland:  D.  Lewis,  Cheatham,  Georgia; 
Frank  Cockey,  Maryland  :  J.  Alvan  Dawson,  Mary- 
land :  Amos  P.  Dodge,  Xew  York:  Elisha  C.  Etchi- 
son,  Maryland:  Wickliffe  Frierson,  Tennessee;  F. 
Denton   Gavin,   Maryland:   J.    Edmund   Gorsuch, 


Maryland;  James  W.  Gurley,  South  Carolina; 
Bezin  W.  Hall,  West  Virginia;  Wm.  Nevitt  Handy, 
Maryland;  H.  T.  Harrison,  Virginia;  Alexander 
Hill,  Maryland;  J.  Rufus  Humphrey,  Virginia; 
J.  Lawrence  Kelly,  Georgia;  George  S.  Kinnemon, 
Maryland;  L.  Mervin  Maris,  Maryland;  Charles  C. 
McDowell,  Maryland;  Wm.  J.  McDowell,  Mary- 
land ;  Edward  S.  Miles,  Maryland;  Robert  B.  Eori- 
son,  Maryland;  Elisha  E.  Mullineaux,  Maryland; 
H.  Eugene  Norris,  Maryland;  George  T.  Perkins, 
Maryland;  Eldridge  C.  Price,  Maryland;  ().  II. 
Williams  Pagan,  Maryland  ;  Wm.  M.  Eeardon,  Vir- 
ginia ;  Albert  J.  Remsherg,  Maryland  ;  Augustus 
Piggs,  Maryland;  Benjamin  S.  Roseberry,  Mary- 
land; Samuel  Rowland,  Maryland;  Thomas  E. 
Sears,  Maryland;  J.  T.  Shepherd,  Georgia;  .1. 
Dawson  Smith,  Virginia;  Benjamin  H.  Todd, 
Maryland;  George  W.  Wiener,  Maryland;  J.  Mar- 
ion Wilkinson,  Maryland;  Willard  H.  Wilson, 
Maryland;  Weems  P.  Winchester,  Maryland. 

University  of  Maryland,  Hon.  S.  Teackle  Wall  is, 
LL.  Dv  Provost. 

Faculty  of  Physic. — Nathan  If.  Smith,  M.  D., 
President  of  the  Faculty  and  Emeritus  Professor 
of  Surgery.  William  E.  A.  Aikin,  M.  D.,  LL.  1)., 
Professor  of  Chemistry  and  Pharmacy.  George  W. 
Miltenberger,  M.  D.,  Professor  of  Obstetrics. 
Richard  McSherry,  M.  D.,  Professor  of  Principles 
and  Practice  of  Medicine.  Christopher  Johnston, 
M.  D.,  Professor  of  Surgery.  Samuel  C.  Chew, 
M.  D.,  Professor  of  Materia  Medica  and  Therapeu- 
tics. Frank  Donaldson,  M.  D.,  Professor  of  Physi- 
ology and  Hygiene,  and  Clinical  Professor  of  Dis- 
eases of  the  Throat,  Lungs  and  Heart.  William  T. 
Howard,  M.  D.,  Professor  of  Diseases  of  Women 
and  Children.  Julian  J.  Chisolm,  M.  D.,  Profes- 
sor of  Diseases  of  the  Eye  and  Ear.  Francis  T. 
Miles,  M.  D.,  Professor  of  Anatomy,  and  Clinical 
Professor  of  Diseases  of  the  Nervous  System.  Alan 
P.  Smith,  M.  D.,  Professor  of  Operative  Surgery. 
L.  MeLane  Tiffany,  M.  D.,  Demonstrator  of 
Anatomy. 


THE  HOSPITAL  BULLETIN  99 

MARRIAGES. 

Dr.   John   Martin   Elderdice,   class  of   1905,   of 


Mardela  Springs,  Md..  was  married  to  Miss  Edna 
Adlcins,  of  Salisbury,  dune   2,   1909. 


Dr.  Gordon  Wilson.  Associate  Professor  of 
Medicine,  was  married  the  early  part  of  June  to 
Miss  Elizabeth  Preston  Elliott,  daughter  of  Mrs. 
Elliott  and  the  late  Warren  Grice  Elliott,  of  2025 
North  Charles  street,  Baltimore,  Md.  The  cere- 
mony was  performed  in  Old  St.  Paul's  ('lunch  by 
Reverend  Dr.  Arthur  Kinsolving.  A  small  recep- 
tion for  the  two  families  and  the  wedding  party 
followed  the  ceremony.  On  their  return  Doctor 
and  Mrs.  Wilson  will  spend  the  summer  at  the 
Chattolanee  Hotel  and  in  the  fall  will  take  pos- 
session (if  their  new  home.  PUS  North  Charles 
street. 


On  April  28,  1909,  in  Amesbury,  Mass.,  Miss 
Annie  Cunningham,  a  graduate  of  the  Univer- 
sity Hospital  Training  School  for  Nurses,  class 
of  1908,  was  married  to  Mr.  William  MacDonald. 


Dr.  J.  Edward  Benson,  class  of  1884,  was  mar- 
ried June  1,  1909,  to  Miss  Laura  Taylor,  a  teacher 
in  the  Hagerstown  schools,  at  the  residence  of 
her  sister,  Mrs.  Beachley,  wife  of  School  Com- 
missioner Harry  K.  Beachley,  by  Reverend  Ed- 
win T.  Mobray,  pastor  of  St.  Paul's  Methodist 
Church.  Doctor  and  Mrs.  Benson  will  spend  their 
honeymoon  in  visiting  points  in  the  North.  After 
their  return  they  will  reside  at  Cockeysville,  Md. 


Dr.  John  R.  Abererombie,  of  Baltimore,  was 
married  Wednesday,  June  13,  1909,  to  Dr.  Anna 
D.  Schultze,  of  Baltimore,  daughter  of  Mr.  and 
Mrs.  William  T.  Schultze,  also  of  Baltimore.  The 
ceremony  was  performed  at  Grace  Protestant 
Episcopal  Church  by  the  Rector,  Reverend  Dr. 
Arthur  Chilton  Powell.  Doctor  and  Mrs.  Aber- 
erombie will  spend  their  honeymoon  in  visiting 


100 


THE  HOSPITAL  BULLETIN 


] mints  of  interest  in  the  North.  On  their  return 
they  will  reside  at  the  Netherelift  Apartments, 
82?   Hamilton  Terrace. 


The  marriage  of  Miss  Mary  Agnes  Browne,  of 
Pittsburg,  to  Dr.  Reuben  Alexander  Wall,  class 
of  1904,  of  this  city,  took  place  Wednesday,  June 
1(5,  1909,  the  ceremony  being  performed  by  Rev. 
Dr.  Van  Dyke,  Rector  of  St.  Mary's  Episcopal 
Church.  The  groom  was  attended  by  Dr.  Edgar 
Allen  Fleetwood,  of  Savannah,  Ga.  After  an  ex- 
tended wedding  trip  Doctor  and  Mrs.  Wall  will 
bo  at  home  to  their  friends  at  Minnifield,  Ed- 
mondson  and  Swan  avenues,  Baltimore. 


Dr.  Walton  Hyde  Hopkins,  class  of  1904,  of  An- 
napolis, was  married  Wednesday,  June  23,  1909, 
tt  Miss  Lila  Holmes  Trenholm,  a  graduate  of  the 
University  Hospital  Training  School  for  Nurses 
and  daughter  of  Mr.  Glover  Holmes  Trenholm. 
The  ceremony  was  performed  by  Reverend  Edwin 
Barnes  Niver,  Rector  of  Christ  Church,  at  the 
home  of  the  bride,  713  St.  Paul  street,  Baltimore. 
Doctor  and  Mrs.  Hopkins,  immediately  after  the 
ceremony,  left  for  a  Northern  wedding  trip  and 
on  their  return  early  in  July  they  will  go  to  their 
future  home  in  Annapolis. 


Dr.  Harry  M.  Robinson,  class  of  1909,  was 
married  to  Miss  Verna  Beatrice  Wilson,  at  Violet- 
ville,  Baltimore   county,   Md.,   May   25,   1909. 


DEATHS. 

Dr.  James  H.  Thomas,  class  of  1851,  died  at 
his  home  near  Hurlock,  Md.,  June  20,  1909,  of 
paralysis.  He  was  nearly  82  years  of  age.  He 
wiis  a  native  of  Dorchester  county,  and  the  son 
of  the  late  Algernon  Thomas.  He  was  graduated 
in  medicine  from  the  University  of  Maryland  in 
1851,  and  practiced  his  profession  for  a  time  at 
Smyrna,   Del,  but   finding  farming  more  conge- 


nial he  moved  to  his  splendid  farm  near  Hurlock. 
He  is  survived  by  a  widow,  who  was  a  Mrs.  Ed- 
niondson,  of  East  Newmarket,  Md. 


Dr.  Walter  Franklin  Fundunberg,  class  of  1850, 
surgeon  of  the  176th  Pennsylvania  Volunteer 
Infantry  Regiment  during  the  Civil  War,  died  at 
Atlantic  City,  November  22,  1908,  aged  80. 


Dr.  George  0.  Johnson,  class  of  1869,  of  Fort 
Cobb,  Oklahoma,  a  member  of  the  American  Medi- 
cal Association,  and  a  member  of  the  Senate  in 
the  First  and  Second  Legislatures  of  Oklahoma, 
died  in  Guthrie,  February  10,  1909,  from  asphyx- 
iation by   natural  gas,  aged  63. 


Dr.  Richard  Evans,  class  of  1886,  of  Butte, 
Mont.,  died  in  a  hospital  in  that  city,  June  8, 
1909,  aged  53. 


Dr.  Legare  Hargrove,  class  of  1891,  of  Nanse- 
mond  county,  Va.,  died  June  16,  1909,  in  a  Nor- 
folk hospital,  aged  about  36  years.  He  is  sur- 
vived by  a  widow,  who  was  Miss  Martha  Driver, 
and  one  daughter. 


Dr.  Luther  Elsworth  Zech,  class  of  1892,  a 
member  of  the  Medical  Society  of  the  State  of 
Pennsylvania  and  of  the  borough  School  Board, 
died  suddenly  at  his  home  in  York,  near  Salem, 
Pa.,  from  angina  pectoris,  aged  47. 


Doctor  Thomas  Perry  Robossom,  class  of  1859, 
died  at  his  home  in  Flintstone,  Md.,  May  28, 
1909,  from  paralysis,  aged  75. 


Dr.  Alexander  Harmon  McLeod,  class  of  1866, 
for  many  years  an  official  of  the  Cincinnati,  Ham- 
ilton and  Dayton  Railroad,  died  at  his  home  in 
Wyoming,  Cincinnati,  May  11,  1909,  from  pneu- 
monia, aged  63. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department   of  the  University  of  Maryland 

PRICE     $1.00     PER     YEAR 


Contributions  invited  from  the  Alumni  of  the  University. 
Business  Address,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-ofHce 
as  Second  Class  Matter. 


Vol.   V 


BALTIMORE,   MD.,  AUGUST  15,  1909. 


No.  6 


REMARKS    OX    THE    CAilSES    AND    THE 
PREVENTION    OF    PARALYSIS. 

By   Irving  J.  Spe.u:.  M.  1).. 

Clinical   Professor  of  Nervous  mid   Mental   Dis- 
eases nt  the  University  u\  Maryland. 

In  the  following  pages  ]  will  call  attention  to 
the  more  frequent  causes  of  paralysis,  limiting 
this  term  to  loss  of  function  of  one  or  more  vol- 
untary muscles.  I  do  not  wish  to  convey  the  im- 
pression that  these  factors  ate  capable  of  bring- 
ing about  only  motor  paralysis,  hut  for  the  pur- 
poses  of  this  paper  J  have  limited  myself,  in  their 
relationship,  to  this  form  of  paralysis.  I  have 
divided  the  various  causes  into  six  groups  and 
then  discussed  each  group  separately.  We  lind 
the  same  factors  at  times  in  more  than  one  group, 
these  bringing  about  deleterious  results  in  more 
than  one  way;  after  a  summary  of  the  principal 
causes  I  have  taken  up  the  discussion  of  the  pre- 
vention of  paralysis,  believing  as  we  all  must,  that 
in  order  to  prevent  paralysis  we  must  first  be  fa- 
miliar with  the  causes,  and  by  preventing  and 
removing  these,  we  may  escape  the  probable  se- 
quelke. 

By  far  the  most  frequent  causes  of  paralysis 
are  diseases  of  the   vascular  system. 

Second   in  frequency  are  the  toxic  agents. 

Third,  trauma. 

Fourth,   infectious  diseases. 

Fifth,  embryonal. 

Sixth,   functional. 

In  discussing  diseases  of  the  vascular  system 
that  may  produce  paralysis,  we  must  consider  the 
manifold  causes  of  arterial  degeneration  and  in- 
flammation. Heredity  here  plays  a  role,  in  so  far 
as  individuals  may  inherit  a  poor  vascular  system 
from  parents  who  are  tubercular,  syphilitic,  alco- 
holic, neurotic,  have  nephritis  or  are  the  subjects 
of  any  other  long-continued  chronic  disease.  In 
early  life  the  most  frequent  cause  of  vascular  dis- 
ease is  infectious  in  nature,  it  is  as  a  rule  only 


after  the  individual  has  passed  the  adolescent 
period,  that  he  is  exposed  to  the  various  causes 
of  an  acquired  arterial  disease.  Of  these  the 
mine  important  are  syphilis,  chronic  intoxica- 
tions, infectious  diseases,  over  work,  worry  and 
chronic    constitutional    diseases. 

The  vascular  system  must  he  affected  in  one  of 
four  ways  to  he  the  causative  agent  of  paralysis, 
or  it  may  lie  affected  in  any  combination  of  these. 
There  must  he  either  occlusion  of  the  vessel 
lumen,  rupture,  deficiency  in  the  vis  a  tergo  of 
the  emulation,  or  deformity  of  a  part  of  the 
rascular  apparatus  bringing  about  abnormal  pres- 
sure against  nerve  elements. 

Vascular  occlusion  may  be  transient, — due  to 
vascular  spasm  or  pressure,  permanent  due  to 
obliteration  of  the  lumen.  The  first  may  be  the 
result  of  emotion,  toxic  agents,  local  irritation  or 
foreign  body;  the  hitter  is  the  result  of  inflam- 
matory or  degenerative  changes  in  the  vascular 
wall,  foreign  body  or  pressure  against  the  vessel. 
Under  this  head  come  thrombosis  and  embolus, 
leading  to  complete  or  partial,  permanent  or  tem- 
porary  occlusion   of  the   vascular   lumen. 

Rupture  of  a  vessel  is  due  to  too  great  a  strain 
from  within  or  tearing  from  without.  When 
caused  from  within,  we  always  have  a  vascular 
wall  weakened  by  some  pre-existing  cause  of  ar- 
terial degeneration. 

Those  cases  due  to  lack  of  force  of  circulation 
are  due  to  a  cardiac  condition,  loss  of  blood, 
shock  or  vascular  relaxation:  this  may  he  tem- 
porary or  permanent    in  duration. 

The  fourth  cause  of  paralysis  due  to  a  vascular 
condition  is  that  produced  by  pressure  of  a  ves- 
sel against  nerve  elements,  for  example,  aneury- 
sm!. 

These  various  states  of  the  vascular  system 
may  exist  in  any  region  of  the  body,  and  de- 
pending upon  the  location  of  this  condition,  will 
be  the  distribution  and  type  of  the  paralysis. 

Toxins  to  give  rise  to  paralysis  must  first  gen- 
erally enter  the  circulation;  they  may  be  exoge- 
nous or  endogenous.     The  exogenous  toxins  gen- 


102 


THE  HOSPITAL  BULLETIN 


erally  enter  the  circulation  by  the  way  <>l'  the 
gastro-intestinal  tract  although  a  few  gain  entry 
through  the  skin  or  respiratory  apparatus.  Cer- 
tain portions  of  the  nervous  system  have  predi- 
lection for  certain  toxins.  The  toxin  acts  by 
causing  inflammation  and  degeneration  of  the 
peripheral  nerves  and  also  has  a  deleterious  effect 
on  the  central  nervous  system.  Exogenous  tox- 
ins,— alcohol  is  by  far  the  commonest  of  these 
and  has  a  selective  action  on  the  peripheral  nerves 
of  both  lower  and  upper  extremities,  arsenic  has 
selective  action  for  the  radial  portions  of  the 
musculo-spiral  nerves,  tobacco  for  the  optic 
nerves,  lead  for  the  plexus  of  Meisner  and  Auer- 
hach.  phosphorous,  silver,  coal  tar  products,  il- 
luminating gas,  carbon  bisulphide,  etc.,  all  are 
capable   of   causing   paralysis. 

Endogenous  toxins-diphtheritic  toxin  affecting 
most  frequently  the  pneumogastrie  nerve,  al- 
though it  may  affect  any  or  all  the  peripheral 
nerves;  la  grippe,  diabetes,  chronic  nephritis,  gas- 
tro-intestinal, rheumatism,  tuberculosis,  syphilis, 
malaria,  typhoid,  typhus,  scarlet  fever,  measles, 
whooping  cough,  erysipelas,  smallpox,  septicemaia, 
gonorrhoea,  etc.,  are  all  capable  of  causing  paraly- 
sis by  means  of  the  actions  of  their  toxins  on  the 
nervous  S)'stem. 

These  toxins  may  act  directly,  affecting  either 
tin.'  peripheral  or  central  nervous  system,  or  may 
act  directly  upon  the  vascular  system,  bringing 
about  degenerative  or  inflammatory  changes  in 
the  vessels  or  heart,  this  possibly  later  on  may 
bring  about  changes  in  the  nervous  system  which 
may  lead  to  paralysis;  thus  showing  that  toxins 
may  act  either   directly   or    indirectly. 

Trauma,  as  a  cause  of  paralysis,  occurs  at  all 
ages  and  may' affect  any  portion  of  the  nervous 
system.  From  birth  when  the  application  of  for- 
ceps to  the  foetus  is  followed  by  the  destruction 
of  brain  tissues  and  rupture  of  blood  vessels,  or 
pressure  on  cervical  nerves  causing  Ebbs  obstet- 
rical paralysis,  to  the  last  days  of  our  existence 
we  are  constantly  exposed  to  harmful  effects  from 
external  violence,  which  may  injure  either  tem- 
porarily or  permanently  brain,  cord  or  nerve  and 
thereby  be  followed  by  temporary  or  permanent 
paralysis. 

Infectious  diseases  as  causative  agents  of  paraly- 
sis may  act  in  several  ways,  the  infecting 
agent  itself  may  directly  invade  the  nervous  sys- 


tem, their  toxins  may  do  harm  at  a  distance,  or 
either  the  toxin  or  infecting  agent  may  involve 
the  vascular  system  and  thus  bring  about  harm- 
ful results.  The  following  is  a  partial  list  of  in- 
fecting agents  that  may  bring  about  paralysis  and 
their  manner  of  doing  so : 

By  means  of  their  toxins — diphtheria,  la  grippe, 
typhoid,  typhus,  scarlet  fever,  measles,  pertussis, 
malaria,  variola,  erysipelas,  septisemia,  pneumonia, 
tuberculosis,  syphilis,  etc.  By  direct  injurious  ef- 
fects on  the  nervous  system — anterior  poliomy- 
elitis, cerebro-spinal  meningitis,  syphilis,  tubercu- 
losis, typhoid,  la  grippe,  erysipelas,  leprosy,  beri 
beri,  scarlet  fever,  smallpox,  gonorrhoea,  Landry's 
paralysis,  etc.  Through  the  vascular  system — 
syphilis,  tuberculosis,  typhoid,  rheumatism,  etc. 

Embryonal  causes  are  the  result  of  some  ab- 
normality in  the  development  of  the  foetus  which 
gives  rise  to  an  imperfect  nervous  system,  this 
imperfection  manifesting  itself  by  symptoms  at 
birth  or  under  the  stress  of  existence,  appearing 
later  in  life. 

True  porencephaius  or  absence  of  a  portion  of 
the  interior  of  the  brain,  the  defect  being  occu- 
pied by  a  prolongation  of  the  cerebral  ventricle 
and  false  porencephaius  or  absence  of  a  portion 
or  the  entire  hemisphere,  the  space  being  filled 
with  cerebro-spinal  fluid,  give  rise  to  paralysis 
affecting  one  or  both  sides  of  the  body. 

Bpinabifida  or  incomplete  development  of  the 
coverings  of  the  cord  or  of  the  cord  and  its 
coverings  may  be  accompanied  by  paralysis  of 
greater  or  less  extent.  The  spinal  cord  itself  is 
sometimes  the  seat  of  deficient  or  defective  de- 
velopment giving  rise  at  any  period  after  birth 
to  certain  diseases;  Freidrieh's  ataxia  due  to  early 
degeneration  of  certain  tracts  of  the  cord;  syring- 
omyelia due  to  the  development  of  cavities  that 
weie    incompletely   obliterated   during   foetal   life. 

Functional  causes  are  those  to  whose  action  we 
aie,  as  yet,  unable  to  refer  a  demonstrable  lesion. 
They  bring  about  their  results  by  interfering  or 
inhibiting  the  normal  co-ordinate  activities  of  the 
higher  psychic  centers.  Fear,  suggestion  and 
autosuggestion  are  the  most  important  and  most 
frequent  acting  functional  causes  which  are  fol- 
lowed by  paralysis. 

The  old  adage  that  an  ounce  of  prevention  is 
worth  more  than  a  pound  of  cure  may  very  well 
be  applied  to  the  prevention  of  paralysis,  as  this 


TIIK  HOSPITAL  BULLETIN 


103 


is  very  frequently  difficult  or  impossible  of  cure 
after  it  has  occurred,  whereas  by  taking  proper 
precaution   il   may  often  be  altogether  avoided. 

The  embryonal  causes,  deficient  and  defective 
brain  and  spinal  cord  formation  may  generally  be 
avoided,  if  only  those  beget  children  who  are 
physically  and  mentally  healthy,  who  are  Tree 
from  hereditary  taint,  who  are  living  a  rational 
life,  if  proper  care  of  the  pregnant  mother  is 
taken,  if  she  is  guarded  Erom  harmful  influences, 
well  nourished,  have  proper  diversions,  g 1  hy- 
gienic surroundings,  and  proper  medical  super- 
vision during  the  pregnant   period. 

The  injuries  that  may  occur  during  delivery 
may  be  minimized  by  competent  medical  atten- 
tion and  if  they  occur  should  be  promptly  and 
properly  treated.  If  the  child  lias  escaped  the 
dangers  of  foetal  life  and  of  the  journey  into 
this  world,  it  will  now  be  exposed  to  the  harmful 
effects  of  trauma,  toxins  and  infection.  Trauma 
should  be  guarded  against  by  careful  supervision, 
toxins  and  infections  by  proper  regulation  of  the 
diet,  this  at  least  if  it  does  not  guard  the  child 
against  toxins  and  infection,  places  it  in  better 
condition  to  resist  their  effects.  If  evidence  of 
intoxication  or  infection  occur  the  condition 
should  be  properly  treated  under  competent 
medical  supervision,  for  even  the  mildest  of 
these  conditions  may  be  followed  by  serious  con- 
sequences. 

With  few  exceptions,  until  early  adolesence, 
the  child  is  exposed  only  to  those  deleterious  fac- 
tors, that  the  parents  alone  can  guard  against 
and  foreset — heredity,  trauma  and  infection.  As 
youth  ends,  and  early  adult  life  begins,  tempta- 
tions assail  the  young  aspirant,  he  is  exposed  to 
the  dangers  of  toxic  subjects  and  venereal  infec- 
tion, woe  to  him  if  he  succumbs,  for  he  has  opened 

the  portal  to  the  enemy,  who  once  having  gai I 

admission  is  difficult  to  dislodge.  1  f  he  has  yielded 
to  the  hue  of  the  drug  or  acquired  venereal  dis- 
ease, he  must  be  promptly  and  properly  treated, 
thereby  avoiding  later  prolific  sources  of  paralysis. 
Excesses  of  eating,  drinking,  emotion,  physical 
and  mental  work,  etc..  should  he  shunned  or  a  be- 
ginning vascular  disease  may  be  inaugurated  with 
its  later  serious  consequences. 

There  should  he  proper  medical  supervision  in 
all  cases  of  illness.  As  old  age  comes  on,  as  it 
must  to  all.  who  has  escaped  life's  earlier  battles,) 


ii  we  would  avoid  its  evident  dangers  we  must  live 
a  lite  ordered  to  avoid  their  causes;  sudden  move- 
ments, constipation,  over  eating  and  drinking,  un- 
wise exposure  to  the  elements,  worry,  violent 
physical  exertion,  neglect  of  physical  and  mental 
ailments,  etc. 

In  conclusion  I  would  advise  the  observance  of 
the  following  general  rules  for  the  prevention  of 
paralysis : 

The  begetting  of  children  only  by  healthy  par- 
ents, proper  care  of  the  pregnant  mother,  and  com- 
petent medical  attention  during  confinement. 

The  proper  feeding  of  the  infant,  good  hygienic 
surroundings  and  prompt  medical  attention  to  all 
ailments. 

Guarding  as  far  as  possible  against  trauma,  in- 
fectious diseases,  etc.,  and  the  prompt  treatment  of 
all  diseases. 

Early  supervision  id'  the  eyes,  ears,  nose,  throat, 
teeth,  et,-. 

A  g I  moral,  intellectual  and  physical  educa- 
tion. Moderation  in  all  habits;  eating,  drinking, 
working  and  playing. 

Avoidance  of  unwise  exposure  to  the  elements. 
The  cultivation  of  a  peaceful  and  contented  dis- 
position. 


TIIK  TREATMENT   OF   CYSTITIS   IN 
WOMEN. 


Pv  I.  S.  Stone,  M.  !).,  Class  1872. 
Washington,  D.  C. 

A  very  common  disease  may  he  easily  over- 
looked and  a  patient  have  an  incurable  disease 
of  her  bladder  because  her  symptoms  were  al- 
lowed (o  continue  while  medical  treatment  is  in- 
stituted without  direct  examination.  In  my  ward 
visit  in  one  of  the  hospitals  with  -which  I  am 
connected,  two  patients  were  recently  turned  over 
lo  my  service  from  the  medical  service.  They 
well  illustrate  my  object  in  writing  this  paper, 
and  I  shall  allude  to  them  to  show  what  is  meant 
by  my  opening  remarks. 

Mrs.  A.,  aged  44,  had  been  having  slight  fever 

for  several   weeks.      She  had  pain   in  the   region 

.of   both    kidneys    and    back   and   had   lost   several 

[pounds   in   weight.      She   had   frequent   mictura- 


104 


THE  HOSPITAL  BULLETIN 


linn  and  a  deposit  of  white  sediment  in  her 
urine.  Examination  of  her  urine  was  negative, 
save  for  epithelial  cells  and  leucocytes.  .She  had 
taken  urotropin,  diuretics,  tonics  and  laxatives, 
etc.,  for  several  weeks.  A  pelvic  examination  had 
not  been  made.  'Our  examination  disclosed  thick- 
ened bladder  walls  with  greatly  diminished  ca- 
pacity— not  over  four  ounces.  This  poor  woman 
probably  has  tuberculosis  of  one  or  both  kidneys, 
with   secondary   ulceration   of   the  bladder. 

The  other  case  was  in  a  colored  woman,  60 
years  of  age,  who  had  also  been  in  the  medical 
sen  ice  of  the  hospital  for  several  weeks.  She 
had  been  unable  to  retain  her  urine,  and  was 
suffering  from  excoriation  and  other  annoyances 
incidental  to  a  constant  leakage.  She  had  also 
taken  "urotropin"  (the  sovereign  remedy  for 
bladder  disease)  and  was  no  better  after  her  resi- 
dence in  the  hospital  than  before.  This  patient 
had  a  bladder  capacity  of  less  than  two  ounces, 
and  her  bladder  felt  like  a  flabby  uterus  between 
the  examining  fingers.  Its  mucosa  was  thick  and 
soft  with  deep  red  color  and  somewhat  ulcerated 
and  incrusted  with  the  usual  deposit  of  ammonia 
phosphates  only  seen  in  belated  and  neglected 
cases. ' 

This  ease  appears  not  to  have  tuberculosis,  but 
merely  a  neglected  bladder  I'nim  local  causes.  It 
would  be  nothing  more  than  right  to  quote  from 
the  prescriptions  given  this  patient  to  show  what 
our  therapeuticians  recommend  for  a  supposed 
"weak  bladder,"  or  weak  "sphincter  meatus 
urinse."  Such  prescriptions  when  printed  along- 
side the  findings  in  a  case  such  as  is  now  being 
described  would  indeed  be  illuminating.  But  I 
forbear  and  will  now  speak  of  the  methods  which 
have  given  the  best  results  to  be  obtained  in 
such  cases. 

Examination.  We  can  never  be  excused  for 
omitting  an  examination  when  a  disease  may  be- 
come chronic  and  possibly  incurable  for  the  want 
of  it.  Nearly  all  the  cases  of  acute  cystitis  are 
easily  curable  by  direct  treatment  by  bladder  irri- 
gation, distension  and  sterilization.  Therefore, 
we  repeat  this  injunction  to  urge  the  necessity 
for  early  and  proper  treatment.  It  would  be 
well  for  every  female  patient  in  the  medical 
wards  who  is  passing  urine  frequently  to  have  an 
examination  by  a  gynecologist.  The  medical  men 
(the   internist)    will  not  practice  the  touch,  and 


hence  cannot  and  in  fact  frequently  do  not  know 
all  that  is  to  be  learned  by  a  pelvic  examina- 
tion. For  instance  in  the  ward  cases  above  men- 
tioned the  routine  urinary  examination  will  show 
the  presence  of  leucocytes"  and  "epithelium." 
There  may  be  no  estimate  of  how  many  leucocytes, 
or  of  what  is  now  often  neglected  in  such  ex- 
aminations, the  quantity  of  mucous  found  in  the 
specimen,  nor  will  anyone  know  the  capacity  of 
the  bladder.  If  this  urinary  examination  is  sup- 
plemented by  a  cystoscopic  investigation,  there  is 
frequently  enough  found  to  explain  all  of  the  ur- 
gent symptoms.  But  we  must  excuse  the  intern- 
ist for  not  appreciating  all  of  the  possible  find- 
ings in  one  of  the  neglected  cases.  There  may 
be  very  interesting  complications  present.  One 
never  knows  what  may  be  found  to  explain  a 
given  case.  We  have  found  annexal  disease  most 
frequently  to  explain  the  presence  of  cystitis  in 
women  although  many  other  causes  are  frequently 
seen.  Calculi  in  the  bladder  or  ureters  may  be 
present  as  jjersistent  irritants,  and  their  presence 
should  always  be  in  mind.  The  enlarged  and 
thickened  ureter  found  in  either  renal  or  blad- 
der cases,  may  be  palpated  in  those  cases  which 
are  not  associated  with  great  thickening  of  the 
bladder  walls,  and  a  stone  in  the  lower  end  of 
the  meter  may  be  located,  and  afford  an  ex- 
planation of  persistent  cystitis.  Obviously  we 
cannot  palpate  the  ureters  when  there  is  asso- 
ciated salpingitis  or  any  induration  or  other  ab- 
normal conditions  present.  To  palpate  the  nor- 
mal ureter  is  generally  impossible,  except  in  very 
expert  hands,  but  it  is  comparatively  easy  to  find 
a  stone  in  the  ureter  if  it  is  near  the  bladder, 
provided  there  is  no  great  disease  of  the  various 
organs  in  the  pelvis. 

Treatment.  A  cardinal  principle  is  to  always 
learn  the  extent  of  the  lesion  in  any  case,  but  in 
these  cases  our  most  important  duty  is  to  meas- 
ure the  capacity  of  the  bladder.  Frequent  mic- 
turition means  one  of  two  things  as  a  rule,  either 
a  very  sensitive  nervous  bladder  or  one  contracted 
from  cystitis.  In  view  of  the  urinary  examina- 
tion one  should  easily  lie  distinguished  from  the 
other.  One  thing  is  evident  and  most  import- 
ant, namely,  that  the  contracted  bladder  cannot 
be  cured  of  cystitis  until  it  is  dilated  and  ster- 
ilized.    We  often  tell  our  internes  that  it  is  quite 


THE  HOSPITAL  BULLETIN 


105 


as  impossible  to  treat  a  lesion  of  a  closed  hand 
without  opening  it,  as  to  attempt  to  cure  a  bad 
cystitis  without  distending  the  bladder.  There- 
fore we  must  first  of  all  fill  the  bladder  perhaps 
three  or  four  times  with  normal  salt-solution,  or, 
better  still,  boric  acid  solution,  using  all  that  the 
patient  will  bear.  The  capacity  can  be  measured 
each  time  the  bladder  is  emptied,  and  it  will  be 
found  that  the  bladder  wall  often  contain  a  few 
ounces  more  at  the  end  of  the  treatment  than 
at  the  beginning.  We  use  ,3  oz.  protargol  solu- 
tion at  piesent,  because  it  is  less  irritating  than 
silver  nitrate,  and  allow  the  patient  to  retain 
this  in  her  bladder  until  the  next  urination.  It 
is  our  routine  practice  to  use  protargol  after  the 
catheter  period  in  any  pelvic  operation,  before 
the  patient  leaves  the  hospital,  as  we  may  ex- 
pect to  find  a  small  amount  of  pus  in  the  urine 
di  all  such  patients,  and  indeed  we  know  of  sev- 
eial  persistently  annoying  cases  resulting  from  a. 
neglect  of  the  above  precaution. 

To  summarize :  We  would  urge  a  careful  pel- 
vic examination  in  all  cases  wdiere  there  is  fre- 
quency of  micturition  with  pus  or  epithelium  in 
the  mine,  whatever  may  be  the  condition  of  the 
patient.  We  would  demand  that  the  capacity  of 
each  bladder  be  measured  as  a  preliminary  to 
regular  treatment  and  we  consider  this  of  greater 
importance  than  a  cystocopic  examination,  save 
in  the  most  expert  hands.  After  the  patient  has 
improved,  and  her  condition  permits  a  proper 
cystocopic  examination,  the  results  will  not  only 
be  less  painful,  but  the  findings  more  satisfac- 
tory. 


STRICTURE  OF  THE  ESOPHAGUS. 


By  Bichard  H.  Johnston,  M.  D., 


Lecturer  on  Laryngology  in  the  University  of 
Maryland;  Surgeon,  to  the  Presbyterian  Hos- 
pital; Consulting  Laryngologist  to  St.  Joseph's 
Hospitad;  Consulting  Laryngologist  to  the  Gen- 
eral and  Marine  Hospital,  of  Crisfield,  Mel. 

June  15,  1909,  Mrs.  J.  H.  M.  was  referred  to 
me  by  Dr.  B.  P.  Bay.     Her  history  briefly  was  as 


follows:  More  than  2  years  ago  she  experienced 
great  pain  on  swallowing,  which  was  located  about 
%  inches  above  the  cardia.  At  times  the  suffering 
seas  so  intense,  she  would  almost  collapse.  Not 
long  after  the  attacks  of  pain  had  disappeared,  she 
noticed  that  the  swallowing  of  solid  food  was  be- 
coming more  and  more  difficult,  until  finally  she 
was  aide  to  take  only  liquid  diet.  When  I  saw  her 
she  had  eaten  no  solid  food  for  2  years;  she  lived 
on  milk  and  was  well  nourished.  In  the  sitting 
position  and  with  the  head  extended  20  per  cent., 
cocaine  solution  was  applied  to  the  throat  and 
esophagus.  Examination  of  the  upper  end  of  the 
esophagus  revealed  nothing  pathological.  The 
10  mm.  esophagoBcope  was  then  passed  and  the 
walls  of  the  esophagus  carefully  examined.  About 
2  inches  above  the  cardia  a  complete  stenosis  of 
the  esophagus  was  found.  No  opening  could  be 
seen,  so  a  fine  probe  was  passed  through  the 
esophagoscope  and  careful  palpation  of  the  cica- 
tricial tissue  made.  The  probe  finally  located  the 
opeiring;  the  smallest  Bunt  bougie  was  then  passed 
through  the  esophagoscope  and  the  stricture 
dilated  under  the  guidance  of  the  eye.  Two  more 
Bunt  bougies,  larger  in  size,  were  passed  in  the 
same  manner  until  the  dilatation  had  reached 
7  mm.  Two  days  later  a  wax  and  fibre  bougie  was 
gently  passed  through  the  stricture.  Aside  from 
slight  soreness  in  the  cardiac  region  the  patient 
presented  no  symptoms.  On  the  fourth  day  she 
swallowed  solid  food  with  practically  no  trouble. 
The  soft  bougie  was  passed  daily  for  a  few  days. 
One  week  after  the  first  dilation  the  esophago- 
scope was  again  passed,  and  instead  of  an  imperme- 
able stricture,  we  found  an  opening  nearly  half  an 
inch  large  with  walls  almost  healed.  The  patient 
was  taught  to  pass  the  soft  bougie  and  was  sent 
home  June  26th,  able  to  swallow  everything.  She 
will  continue  the  treatment  at  home  gradually 
lengthening  the  intervals  between  the  bougieings 
until  one  passage  monthly  will  be  sufficient  to  keep 
the  opening  patent.  She  had  been  treated  for 
months  by  the  old  method  unsuccessfully  and  had 
given  up  hope  of  any  improvement.  It  is  probable 
that  she  would  eventually  have  closed  entirely  and 


106 


TDK   HOSPITAL  BULLETIN 


a  gastrostomy  would  have  been  necessary.  The 
cause  of  the  stricture  was  probably  an  ulcer  of  the 
esophagus  which,  in  healing,  gave  rise  to  the  cica- 
tricial contraction.  The  result  in  this  case  was 
brilliant  as  compared  with  a  gastrostomy,  limit's 
bougies  are  most,  valuable  for  dilating  strictures. 
They  are  made  with  two  olive  tips  about  1.5  inches 
apart.  The  smallest  bougie  has  an  end  tip  no 
larger  than  a  line  probe,  so  that  after  the  opening 
is  located  it  is  used  as  a  probe  and  as  a  guide  Cor 
the  larger  olive.  Once  through  the  stricture  with 
the  small  tip,  force  can  hi'  applied  to  the  second 
olive  with  no  danger  of  making  a  false  passage. 
Since  everything  is  dune  through  the  esophago- 
scope,  the  operator  sees  every  step  id'  the  treat- 
ment. It  is  obvious  that  the  danger  id'  making  a 
false  passage  is  practically  done  away  with'.  After 
the  stricture  is  dilated  to  ?  of  8  mm.,  it  is  safe  to 
pass  the  wax  ami  fibre  bougies  in  increasing  sizes. 
The  most  difficult  part  of  the  treatment  is  the  first 
dilatation  ami  this  is  made  easy  through  esophago- 
scopy. 


A    (ASK   (iK    PYLolMC   CARCINOMA. 


By   Robert   IL  (Jaxtt.  '09. 


Senior  Medical  Student. 

Patient  a  white  male.  Spaniard  by  birth,  is  oi 
a  small  statute,  but  fairly  well  developed.  60 
years  of  age.  Jlis  past  history  is  negative,  as 
he  docs  not  remember  having  bad  those  diseases 
incident  to  childhood  and  as  well  as  he  remem- 
bers has  always  been  a  healthy  individual.  There 
is  nothing  in  his  family  history  pointing  towards 
his  present  trouble. 

Piescnt  illness:  About  June,  1908,  be  began 
vomiting  almost  every  time  he  would  eat.  The 
vomitus  was  irregular  in  quantity,  at  times  fol- 
lowed by  considerable  retching,  hut  never  at  any 
time    containing    any    blood. 

IIi~  liist  signs  id'  pain  would  come  on  follow- 
ing attacks  of  vomiting  and  at  first  were  felt  in 
the  upper  abdominal  region  just  to  the  left  .id' 
the  xiphoid  cartilage.  Prom  this  point  it  spread 
laterally  and  over  lower  abdominal  regions.  The 
pains   aie   of   a    sharp   and    intense  character.      He 


is  constipated,  and  it  is  necessary  to  purge  him 
daily.  Pain  is  of  a  much  less  intensity  follow- 
ing the  use  of  cathartic.  Bowels  were  regular 
before    the   onset    of    this    present    illness. 

Examination  reveals  an  irregular  nodular, 
movable  lump  in  the  region  of  pylorus.  Patient 
states  that  this  lump  seems  to  disappear  after 
attacks  id'  nausea.  Hepatic  dullness  is  increased 
inferiority.     Appetite   is  poor. 

Las  lost  considerable  weiglit,  his  present  weight 
being  103  lbs.  Skin  is  of  dry.  yellowish  look,  pre- 
senting evident  signs  of  cachexia  and  emaciation. 
Facies  are  those  of  one  worried  and  anxious.  Ex- 
amination of  heart,  lungs  and  kidneys  negative, 
arteries  are  somewhat  sclerotic,  but  the  pulse  is 
regular  in  tone  and  rytlnn  and  its  volume  is  good. 

Kiine:  Clear,  sp.  gr.  1026  React,  acid.  Al- 
bumen, sugar.  Blood,  negative.  Sed.,  scant, 
containing  a  few  renal  epithelial  cells  and  ainor- 
phus    urates. 

Blood:      Leucocytes    8,600. 

Erythrocytes    4,800,000.      Haemoglobin    70%. 

Stomach    contents.      Total    acidity    56    degrees. 

Free   11. CL.  0.0876%.     Microscopic  examination 

shows   an    excess   of    starch    granules,    hut    no    Op- 

.  plen  Bras  bacilli  and  no  sarcinae. 

Temperature  upon  admission.  97.4  K..  pulse  GO 
to  minute,  respiration   18. 

Diagnosis:  Pyloric  carcinoma.  Patient  en- 
tered hospital  on  October  12,  PHIS,  and  was  or- 
dered for  operation  the  morning  id'  14th.  Noth- 
ing by  mouth  was  given  for  twelve  hours  pre- 
ceding and  the  stomach  was  lavaged  on  the  morn- 
ing of  the  operation. 

Operation:  Operator,  Or.  F.  Martin;  Assist- 
ant, Or.  Lynn:  Anaesthist,  Dr.  Richards;  an- 
aesthetic, ether. 

Patient  was  carried  to  operating  room,  and 
pupated  for  an  aseptic  operation,  abdomen  being 
scrubbed  with  green  soap,  sterile  water,  alcohol, 
ether  and  bichloride.  An  incision  was  made 
opening  the  upper  abdomen,  in  median  line — in- 
cision about  eight  inches  in  length.  The  stomach 
was  markedly  dilated  and  at  the  pyloric  orifice 
a  large  malignant  growth,  carcamatous  in  char- 
acter was  found.  The  vessels  supplying  the  py- 
lorus, viz:  the  gastric,  pyloric,  gastro-epiploca 
dextra    and    pancreatic    duodenalis   superior   were 


THE  HOSPITAL  BULLETIN  107 

ligated  with  linen  thread  and  cut.  The  pyloric  discontinued  on  the  second  day  following  opera- 
ends  of  the  stomach  and  duodenum  were  then  ticn,  as  was  also  the  rectal  infusion  of  normal 
freed   from  their  niesentefic  attachments  and  the  sail    solution. 

ends  of  the  pylorus  and  duodenum  at  a  sufficient  About  one  week  subsequent  to  the  operation,  he 
distance  above  the  growth  were  tied  with  heavy  complained  of  pain  and  tenderness  upon  pres- 
tape  to  prevent  the  escape  of  contents  into  the  sure  at  tlie  upper  extremity  of  the  wound.  Para- 
peritoneal cavity.  Purse-string  sutures  were  in-  llnn  revealed  a  sense  of  bogginess  and  it  was 
serted  at  these  locations  where  sections  were  to  thought  there  was  a  collection  of  pus  in  this  lo- 
be made  and  the  cancerous  growth  removed.  The  cation  due  to  leakage  from  the  stomach.  There 
free  ends  id'  the  duodenum  ami  stomach  were  Was  a  slight  rise  in  temperature.  Three  days 
cauterized  with  pure  carbolic  acid  and  washed  nil'  |atlT  t;1(.  collection  worked  itself  to  the  surface 
with  alcohol  and  invaginated,  the  purse-string  an,i  the  abscess  evacuated  itself.  A  small  rubber 
sutures  heing  tightly  lied,  ami  reinforced  by  a  tube  was  inseited  for  drainage.  The  temperature 
continuous  Lembert  suture.  The  tape  ligatures  iin«l  pulse  immediately  fell  to  uormal  and  re- 
were  then  removed   from  the  bowel  and  stomach,  tnained   so. 

Xevta    posterior  gastrojejunostomy   was   done,   a  Qn    October  26,  or   twelve  days   following   the 

hole  being  torn  through  the  transverse  meso  colon  „|1(,||||illlK  he  was  allowed  a  Bpecial  sof,  diet,  ,.„„_ 

and     the    jijenum     being    sutured     to     posterior  ^sting  of  Boft  toast,  milk  and  broths;  two  days 

stomach  wall  about   iy2  inches  above  the  greater  |;|(r|  ||r  was  given  potatoes  and  allowed  poit  wine, 

curvature  and   3   inches   from   the  pyloric  slump.  hvj(.(i  (|.|i|y  .mi|   pCT,nittet1   to  sil    up.     His  Condi- 

The  jijenum  and  stomach  wall   wen.  held  tightly  tjmi   continue(1   to   improve  and    three   weeks   Eol- 

witll    Monihens   clamps,    the   anastomotic    incisions  [owJng  (||(,  operation    hl.  was  allowed    to   walk   and 

made,    and    sutured   first    with    the   Council,   and  paitake   ,,r    .,    „VIU.,11US    diet.      lie    now    weighed 

then   reinforced  with  continuous  Lembert  sutures  lf)5    ,bg_      t1r,    absce8a    ,,.,,.,    al    upper    end    of 

of    line   black   silk.     The    fore   end    of   the   dm-  wmm]   wag   rap1diy    m  1  i  1 1  --   in   and    he  seemed    in 

deiiuin   was   then   sutuicd    to   the   mesentery.     All  :i  ,., in,| j t i,,n 

lucks  and  gauze  packing  were  then   removed,  the         ....  ,  , ,,  r 

1          •  On    November    1.    1908,    the    patient    was   dis- 

periloneimi     ami     fascias    closed     with     line     black  ,            ,        ...         1111             1        1    s        a         1,,., 

1  charged.      Wound    had    been   closed    tor   live  days 

silk  ami  the  wound  closed  with  a  subcutaneous  sil-  .  .        .     .                     .     . 

and    his   general    condition    had    \en    mucli    tm- 

vcr  wire  suture.     Silver  foil   and   stock  dressings  ,      tl     .       ,.    ,    ,         ,         ,,      ,     ,  -,  ,,  . 

proved.      Duung   Ins   last    week    in   the   hospital    he 

were    applied    ami    Ihe    patient    returned    to    his  ..                .   ,           ...           ,... 

11                                '  luiil   named   (>'  -_   lbs.   in    weight,   and   his  condition 

loom   in    fair  condition,   he  being  slightly   shocked. 

is  quite  a  contrast  to  that  ol   live  weeks  ago  upon 

Duiing  the  operation  strychnine  was  administered  ..                  1;                -,    •  . 

0           '                   J  entrance.     Instead  ol  discontent,  distress  ami  evi- 

to  the  extent  of  1/15  of  a  "-rain  and  immediately  ,                                    .         .  ,      ,                    ,      „,,. 

dent  imhapprness  and  anxiety,  he  now  is  cheerlul. 

following    a    rectal    infusion    of    normal    salt    was  ,,,,,,.,1    ,.,,,,,1; 

8  contented   and   comfortable,      ins  general   conai- 

administereil,    and    ordered              g.    four    hours,  ,   ,      .          ,  K          ,■ 

lion  is  decidedly  better  ami   he  is  paitainng  ol   a 

strychnine  1/30  g.  four  hours.  .    ..          ...           ..         ,. 

'       ■  lihcial    diet,   with   no  cliscomiort. 

Following   the   operation    the   patient   had    some 
slight   reaction,   hut    this   soon    Subsided,   tempera 


Flu-   patient   was   heard    from   about    Fein  nary 


ture  and  pulse  remaining  normal.     Nothing  was  1-  and   was  doing  well,      lie  had   returned  to  his 

given  by  mouth  until  second  .lay  following,  when  work,   that   of   a   cigar   maker,   and    was   suffering 

small    quantities   of   albumen    water   were   allowed.  no    discomfort    or    distress.       In    his    own    wo, ds. 

The  patient  was  resting  well  and  stimulation  was  he   was   very   happy   and    enjoying   hie. 


108 


THE  HOSPITAL  BULLETIN 


DIAGNOSIS  IN  CHILDHOOD. 


By  Nathan  Winslow,  M.  D., 

During  the  first  few  years,  the  physician  has  to 
rely  upon  the  objective  signs  of  disease,  for  the 
child  is  unable  to  describe  its  subjective  symptoms, 
but  the  two  following  fundamental  principles  are 
of  great  assistance  in  arriving  at  a  proper  diagno- 
sis; on  the  one  hand  it  is  a  well  known  fact  that 
pathological  processes  at  this  period  of  life  are 
practically  limited  to  the  gastro-intestinal  tract. 
the  lungs,  and  the  brain:  and  on  the  other  hand 
owing  to  the  extreme  susceptibility  of  .the  nervous 
mechanism  of  infants,  functional  derangements 
are  often  accompanied  by  very  grave  symptoms, 
and  may  even  prove  fatal  in  twenty-four  hours, 
or  there  may  be  speedy  and  complete  recovery  after 
very  alarming  symptoms. 

In  seeking  a  diagnosis,  it  is  best  to  start  with 
the  history  which  may  be  obtained  from  the 
mother,  after  which  a  methodical  physical  exami- 
nation is  in  order. 

History. — The  previous,  as  well  as  present  his- 
tory of  the  child  should  be  minutely  investigated. 
The  nature  of  the  delivery,  whether  normal,  in- 
strumental, tardy,  or  precipitate,  is  an  extremely 
valuable  aid  to  diagnosis.  In  disturbances  of  nutri- 
tion not  only  enquire  about  the  nature  and 
amount  of  the  food  given,  but  also  how  prepared. 
Do  not  fail  to  ascertain  whether  the  child  has  been 
gaining  or  losing  weight.  Investigate  the  time  of 
the  eruption  of  the  teeth.  Ask  at  what  time  the 
child  began  to  stand  and  walk  alone.  Make  it  a 
point  to  ascertain  the  acute  infectious  diseases  the 
baby  has  had.  Find  out  the  time  of  onset  of  the 
]■  resent  malady,  and  how  it  was  ushered  in.  Ask, 
if  the  temperature  has  been  elevated;  if  there  has 
been  any  cough;  if  there  has  been  any  evidence  of 
pain.  Observe  whether  the  child  is  restless.  In- 
vestigate the  character  of  its  sleep.  The  bowels 
should  not  be  overlooked,  learn  whether  they  are 
constipated  or  loose,  and  the  number  and  amount 
of  the  stools  passed  in  a  day.  The  amount  of 
urine  and  the  frequency  of  micturition  should  be 
fully  ascertained.     Question  the  parents,  in  case 


of  suspected  congenital  syphilis,  about  their  pre- 
\  Lous  life. 

Physical  Examination. — In  order  to  make  a 
thorough  examination,  our  ingenuity,  time,  skill, 
perseverence,  and  tact  are  taxed  to  the  utmost, 
before  the  desired  information  is  obtained.  In  go- 
ing over  a  case,  exactly  the  same  method  of  pro- 
cedure is  followed  as  in  the  adult.  Begin  with  an 
inspection  of  the  different  regions  of  the  body, 
palpation,  percussion,  auscultation,  and  the  vari- 
ous instruments  of  precision  have  their  fields  of 
usefulness,  but  in  any  case  patience,  tact  and  time 
are  essential  to  a  proper  and  thorough  examina- 
tion. 

[nspection. — Bare  the  part  to  be  examined, 
even  without  touching  the  child,  especially  if 
asleep;  very  important  information  can  be  gained. 
If  the  child  is  asleep,  note  whether  it  lies  on  its 
face  or  back.  In  cerebral  involvement  it  may  be 
in  a  position  of  opisthotonus.  Note  whether  the 
sleep  is  (pliet  or  disturbed,  whether  the  respirations 
are  normal  or  abnormal,  whether  there  is  an  erup- 
tion on  the  body,  whether  there  is  athetosis. 
Palpable  deformity  is  obvious. 

Skin. — The  color  of  the  skin  should  not  be 
neglected  for  it  often  gives  us  important  clues  to 
the  pathological  process  going  on.  In  anemia  one 
is  struck  by  the  extreme  degree  of  palor.  In 
chronic  indigestion  the  skin  takes  on  a  peculiar 
hue,  and  is  often  wrinkled  from  absorption  of  the 
subcutaneous  fat.  A  bluish  tinge  of  the  lips  or  a 
cyanosis  of  the  extremities  should  direct  our  at- 
tention to  the  heart,  or  lungs,  and  is  due  to  a 
sluggish  capillary  circulation.  In  obstructive  dis- 
eases of  the  upper  air  passages,  the  patient  takes 
on  a  leaden  color.  In  shock  the  skin  is  pale,  cold, 
and  clammy.  In  the  eruptive  diseases  the  skin  is 
of  the  utmost  importance  in  diagnosis. 

Attitude.-— A  healthy  child,  when  not  asleep, 
should  be  more  or  less  constantly  in  motion.  When 
you  encounter  a  child  over  six  months  of  age  not 
active,  it  in  all  probablity,  is  suffering  from  mal- 
nutrition. When  a  child  eighteen  months  of  age 
does  not  walk,  you  should  think  of  rickets  as 
being  the  probable  cause.     If  upon  inspection   a 


THE  HOSPITAL  BULLETIN 


109 


jrint  is  found  in  semi-flexion,  yon  may  be  cer- 
tain an  inflammation  is  present.  If  the  child  is 
suffering  from  a  unilateral  pneumonia,  it  will  lie 
upon  the  affected  side,  which  upon  inspection  will 
lie  found  to  be  motionless.  In  diseases  of  the  cir- 
culatory system,  the  posture  is  of  great  import- 
ance as  a  guide  to  diagnosis.  In  cardiac  dilatation 
a  semi-flexed  sitting  posture  is  assumed.  In  deep 
seated  abdominal  inflammations  the  patients  lie 
unon  their  back,  the  muscles  are  rigid,  and  the 
thighs  are  flexed  on  the  pelvis,  and  the  legs  upon 
the  thighs.  In  meningitis,  when  the  intellect  is 
affected,  the  child  will  lie  in  bed  in  one  position. 
"Whenever  yon  see  an  arm  drop  helplessly  as  in  the 
dissecting  room,  there  is  an  extreme  decree  of  in- 
toxication. In  Pott's  di=easc  the  posture  is  very 
characteristic.  In  children  many  of  the  acute  in- 
fections diseases  are  ushered  in  by  convulsions. 
Tf  these  occur  at  the  onset  of  the  malady,  thev 
are  not  as  serious  as  those  which  take  place  at  the 
termination  of  the  illness. 

Movements. — There  is  a  group  of  diseases 
(nervous)  whose  presence  is  indicated  by  certain 
movements.  In  tubercular  meningitis  the  head 
i«  continually  turned,  from  side  to  side,  and  the 
hand  at  the  same  time  is  carried  to  the  head.  Tn 
ca°e  of  hunger  the  babe  grasps  at  everything  within 
reach,  and  is  constantly  putting  its  hand  to  its 
mouth.  It  should  be  borne  in  mind  that  in  many 
chest  diseases,  the  patient  will  nib  its  abdomen. 

Cry. — The  cry  of  the  child  is  of  considerable 
importance  as  an  aid  to  the  diagnosis  of  quite  a 
number  of  diseases.  One  should  be  able  to  recog- 
nize whether  it  is  due  to  anger,  pain,  habit,  hun- 
ger, etc.  Do  not  say  the  child  hasn't  pain,  if  there 
are  tears,  for  they  are  not  present  before  the  second 
month.  The  cry  of  hunger  is  not  sharp  or  pierc- 
ing, but  is  long  continued,  and  the  hands  are  con- 
tinually carried  to  the  mouth.  The  cry  of  pain 
within  the  first  two  weeks  of  life.  In  this  case 
the  cry  is  loud,  and  prolonged ;  the  body  of  the 
child  is  stiffened ;  the  head  is  thrown  back ;  and 
the  child  kicks  violently.  Extreme  degrees  of  ex- 
haustion are  characterized  by  a  low.  feeble  whine 
or  moan.  The  cry  of  habit  is  very  difficult  to 
recognize,  but  can  be  told  by  the  child  ceasing  to 
cry,  when  its  wants  are  satisfied. 


Certain  diseases  have  characteristic  cries,  as  the 
short,  catchy,  suppressed  cry  of  pneumonia;  the 
sharp  nocturnal,  hydrocephalic  cry  of  tubercular 
meningitis;  the  hoarse,  nasal  cry  of  congenital 
syphilis;  and  the  suppressed  muffled  cry  accom- 
panying atelectasis. 

■  Vomiting  is  very  much  more  frequently  ob- 
served in  childhood  than  later  in  life,  and  has  not 
the  same  significance.  Owing  to  the  more  vertical 
position  and  size  of  the  stomach  food  in  overdis- 
tention  is  very  frequently  regurgitated.  Gastro- 
intestinal  affections  are  sometimes  cured  by  vomit- 
ing. The  act  of  vomiting  often  serves  as  an  indi- 
cation of  beginning  infectious  diseases,  such  as, 
scarlatina,  measles,  lobar  pneumonia,  which  later 
in  life  are  ushered  in  by  a  chill.  Vomiting  is 
sometimes  an  indication  of  nephritis.  In  cases  of 
peritonitis  and  appendicitis,  vomiting  occurs  as  a 
very  early  symptom. 

Mouth. — The  mouth  and  tongue  are  often 
characteristic  of  certain  diseases,  e.  g.,  measles,  etc. 
Lesions  of  congenital  syphilis  make  their  appear- 
ance on  the  mucous  membrane  of  the  cheeks.  The 
tongue  likewise  gives  us  important  information 
about  changes  occurring  in  the  body.  In  many  of 
the  diseases  of  the  stomach  and  intestines  the 
tongue  is  drv  and  shows  a  tendency  to  crack.  In 
exhaustive  diseases,  it  is  coated  with  a  whitish, 
yellowish,  or  brownish  debris.  In  scarlet  fever  we 
have  the  strawberry  tongue.  In  nervous  exhaus- 
tion it  often  is  very  much  swollen.  One  of  the 
cardinal  signs  of  scurvy  is  the  swollen  and  hemor- 
rhagic condition  of  the  gums. 

Throat. — Never  omit  an  examination  of  the 
throat.  Look  on  the  hard  palate  for  the  eruptions 
of  the  acute  infectious  diseases. 

Stools. — Never  neglect  to  inspect  the  stools 
yourself  in  bowel  complaint,  as  some  important  in- 
formation may  be  derived  by  this  procedure.  Pure 
blood  is  seldom  passed  by  these  tiny  patients,  it  is 
due  to  hemorrhoids,  to  which  children  are  exempt, 
or  to  some  obstruction  of  the  lower  bowl.  In 
enterocolitis  you  have  blood  mixed  with  mucus  in 
the  fecal  mass. 

Urine. — The  urine  should  be  subjected  to  the 
same  tests  as  adults,  and  the  physician  should  make 
it  a  routine  practice  in  every  physical  examination 


110 


THE  HOSPITAL  BULLETIN 


to  examine  this  secretion.  In  the  male  it  may  be 
collected  in  a  con&um,  in  the  female  in  a  cup 
fastened  over  the  vulva. 

Pulse. — Changes  in  the  rhythm  of  the  pulse  are 
not  so  significant  as  later  in  life.  See  if  it  is 
rapid  or  slow;  full  or  strong;  soft  or  compres- 
sible. A  slow,  irregular  pulse  often  suggests 
meningitis. 

Heart. — Acquired  organic  heart  disease  does 
not  as  a  rule  appear  until  the  third  year.  If  loud 
murmurs  are  heard,  they  are  almost  certainly  of 

congenital  origin,  soft  ones  are  functional. 

Respirations. — Changes  in  rhythm  of  lespha- 
tions  are  not  so  significant  as  later  in  life.  Note, 
whether  it  is  regular  or  irregular;  whether  slow, 
rapid,  easy,  quiet,  snoring,  or  noimal.  Mouth 
breathing  may  be  caused  by  ti  nisi  litis,  adenoids. 
diphtheria  or  any  congestive  affection  of  the  nasal 
passages. 

Temperature. — In  making  an  examination  of  a 
child,  always  ascertain  whether  fever  is  present. 
To  get  this  properly,  do  not  rely  upon  the  mouth 
or  axillary  method,  but  take  it  pel'  rectum.  The 
average  temperature  of  the  child  is  99°  F.  Nerv- 
ous, high  strung  children  are  prone  to  take  on  fever 
on  the  slightest  provocation.  This  rise  is  due  to 
a  functional  disturbance,  and  subsides  after  a  lew 
hours.  Underfeeding  is  followed  by  a  rise  in  tem- 
perature". The  temperature  of  premature  chil- 
dren is  often  subnormal,  but  can  he  raised  by  arti- 
ficial means.  I'ulse  rate  and  lone  aie  of  more  im- 
portance than  the  range  of  the  thermometer. 

Facial  Expression. — Note  whether  the  fea- 
tures are  calm,  or  drawn  and  anxious,  intelligent  or 
stupid..  Pain  frequently  manifests  itself  by  con- 
traction of  the  facial  muscles. 

Cough. — Carefully  ascertain  whether  the  cough 
is  constant,  barky,  croupy,  light,  loose,  or  Severe; 
and  the  nature  id'  the  sputum,  expectorated  should 
not   lie  overlooked. 

Eyes. —  If  the  mother  has  a  vaginal  discharge, 
the  eyes  should  receive  careful  attention,  else  they 
may  give  great  trouble  and  anxiety.  Ascertain  in 
an  examination  id'  these  organs,  whether  the  pupils 
lead  to  light,  and  whether  they  are  dilated  or  con- 
tracted. Interstitial  keratitis  indicates  the  pres- 
ence  of  congenital  syphilis. 


NOSE, — Any  nasal  discharge  should  be  carefully 
noted.  If  acute,  suspect  diphtheria,  scarlet  fever, 
influenza;  if  chronic,  the  most  likely  causes  are 
adenoids  and    syphilis. 

Abdomen. — Look  for  tympanitis  and  points  of 
tenderness.  Note  whether  the  abdomen  is  re- 
tracted as  in  meningitis.  Try  to  palpate  the  dif- 
ferent abdominal  viscera,  for  the  liver  and  the 
spleen  are  sometimes  found  to  be  displaced;,  especi- 
ally, in  contractions  of  the  chest  due  to  tickets. 
In  acute  diseases  an  enlarged  spleen  suggests 
malaria,  typhoid  fever,  tuberculosis;  in  chronic 
maladies,  malaria,  syphilis,  and  leukemia. 

Bones. — Be  sine  to  note  any  enlargement  of  the 

osseous  structure  and  always  look  for  points  of  ten- 
derness. 

Skull. — Determine  by  running  the  fingers  over 
the  head,  whether  the  fontanelles  ami  sutures  aie 
opened  or  closed. 

Glands. — Enlarged  cervical  glands  may  lie  due 
to  acute  tonsilitis,  diptheria,  measles,  etc.,  so  do 
net  fail  to  examine  them  when  going  over  a 
patient,  as  they  may  guide  us  to  a  proper  diagnosis. 

General  Condition. — Observe  whether  the 
mu  sell's  aie  llahbv  or  well  nom  is  bed  ;  whetlier  there 
is  any  deformity  of  the  bony  system.  Investigate 
depends  upon  its  severity.  It  is  sharp  and  pierc- 
ing, tlie  features  aie  contorted,  and  there  are  other 
signs  of  distiess.  The  cry  of  temper  is  present 
sight,  speech,  and  general  menial  development.  If 
the  child  is  able  to  lell  its  Symptoms,  do  not  In  In 
obtain  I  he  facts  desiied   too  quickly. 

Palpitation. — The  hands  must  be  warm.  We 
rarely  fail  to  get  the  fremitus  of  the  civ,  and  this 
is  usually  great,  <]uc  to  the  thin  walls.  Mucous  in 
lubes  will  be  indicated  by  a  rhonchial  fremitus,  and 
is  signilicant  of  bronchitis.  Locate  apex  beat  of 
the  heart,  which  is  usually  in  fourth  intercostal 
space. 

Percussion. — To  percuss  the  back,  have  the 
nurse  resl  the  child  over  her  shoulder.  Owing  to 
the  thin  chest  walls,  and  large  bronchi  the  percus- 
sion note  is  rather  tympanitic,  and  is  exaggerated 
on  the  i  ight  side. 

Auscultation. — Ausculate  the  posterior  chest 
wall  first  as  the  child  is  not  so  apt  to  be  frightened, 
also  because  evidence  of  disease  oftentimes  lirst 
makes  its  appearance  here. 


THE  HOSPITAL  BULLETIN 


111 


THE   HOSPITAL  BULLETIN 

A   Monthly  Journal  of   Medicine  and  Surgery 
EDITED    BY 

A    COMMITTEE    OF    THE    HOSPITAL    STAFF 


PUBLISHED    BY    THE 

HOSPITAL  BULLETIN. COMPANY 
University  of  Maryland 


Business  Address, 
Editorial  Address,     . 


.     .      .       Paltimore,  Md. 
University  of  Maryland 


Baltimore,  Md.,  August  15,  1909 

THE  SOUTH'S  PROSPERITY.  THE  OPPOR- 
TUNITY POP,  EDUCATIONAL  INSTI- 
TUTIONS  OF   BALTIMORE. 

The  marvelous  natural  resources  <>t'  the  South 
summed  up  by  Mr.  <J.  (J.  Dawe  in  an  ad- 
dress delivered  at  the  meeting  of  the  Southern 
Commercial  Secretaries'  Association,  Atlanta,  Ga., 
recently,  almost  stagger  the  imagination  of  peo- 
ple who  have  not  investigated  the  great  possi- 
bilities for  developmenl  in  the  agricultural  and 
commercial  growth  of  the  Southern  States.  Mr. 
Dawe  shows  that  the  South  has  the  largest  ana 
of  workable  land  awaiting  agricultural  develop- 
ment of  any  section  of  this  country;  that  she  has 
II  per  rent,  of  the  standing  timber  of  the  United 
States;  of  navigable  riveis  to  the  total  mileage 
of  26,410  miles,  the  South  has  l8,21o  miles.  She 
has  3,000  miles  of  coast  line,  while  the  Atlantic 
ami  Pacific  Coasts  combined  have  only  2,400  miles. 
She  has  thriving  ports,  which  when  the  Panama 
Canal  is  opened,  will  preseni  enormous  oppor- 
tunities to  trade  with  the  South  American  coun- 
tries. The  Southern  people  an1  ta-i  awakening  to 
a  realization  of  the  possibilities  of  development  id' 
these  vast  resources  in  manufacturing,  mining  and 
agriculture.  She  is  forging  ahead  with  marvelous 
speed. 

In  matters  of  education  the  Southern  universi- 
ties, colleges,  public  ami  private  schools  arc  grow- 
ing in  like  proportion.  Baltimore  being  the  lead- 
ing metropolis  of  the  South,  should  he  made  a  cen- 
ter id'  her  educational  Interests.  By  reason  of  ber 
population,  her  climate,  her  social  advantages,  she 
presents  facilities  for  educational  training  not  pos- 
sessed by  any  other  city  in  the  South  and  not  sur- 
passed hy  any  city  in  the  Ninth. 


Baltimore  should  he  made  a  great  educational 
Center  and  it  would  he  wise  upon  the  part  of  our 
educational  institutions  to  reach  out  after  stu- 
dents   from   the   South.      They    can    tind    in    Balti- 

re  opportunities  which  .cannot  he  found  in  other 

cities.     These  facts  apply  with  special  force  to  the 
medical  school-  of  our  city. 

We  have  in  Baltimore  six  medical  schools  uow 
in  active  operation  and  educating  over  1,500 
medical  students.  It  will  lie  an  easy  matter  for 
these  institutions  to  double  the  number  of  stu- 
dents from  the  South  as  well  as  from  the  North, 
if  the  advantages  of  education  are  properly  pre- 
sented  to  the  large  body  of  young  men  who  are 
seeking-an  education  in  medicine.  The  medical 
schools  of  Baltimore  possess  unusual  advantages 
for  scientific  and  clinical  instruction.  With  hos- 
pitals and  laboratories  well  equipped  for  instruct- 
ing students,  with  teaching  bodies  well  organized 
and  trained  for  giving  instruction,  it  is  possible 
to  give  an  education  m  medicine  that  will  equip 
the  medical  student  for  the  highest  work  in  his 
profession. 

It  remains  for  the  institutions  of  this  city  to 
present  in  a  forcible  way,  the  opportunities  which 
lhe\  cm  offer  to  the  medical  student  and  the 
Bulletin  is  of  the  opinion  that  those  institu- 
tions which  get  in  -line  and  make  good  in  their 
work  of  instruction  will  prosper  through  the  op- 
portunities which   will   he   presented  to  them. 

Baltimore  possesses  a  (Innate,  a  social  life  ami 
all  the  desirable  features  which  should  make  the 
residence  of  the  student  here  a  profitable  one. 
Tlie  amount  of  clinical  material  to  he  round  in 
our  larger  hospitals,  if  fully  utilized,  could  he 
made  to  give  lwo-1'old  the  amounl  of  instruction 
which    is  now    del  ived    from    it. 

In  reaching  out  after  students,  it  would  he 
well  for  the  medical  institutions  of  Baltimore  to 
emphasize  the  fact  that  clinical  teaching  and  lab- 
oratory instruction  can  he  found  here  in  the  great- 
est abundance. 

The  immense  development  of  the  Smith's 
material  wealth  is  Baltimore's  opportunity.  Her 
commercial  bodies  realizing  the  source  of  the 
Smith's  vasl  wealth,  ate  using  every  effort  to  a(- 
ii.et  attention  to  this  city  as  a  manufacturing 
ami  distributing  center.  Why  should  not  medi- 
cal schools  of  this  city  realize  the  position  which 
they  enjoy  and  organize  with  the  same  purpose 
ill  view  ? 


112 


TIIK    HOSPITAL   lil'LLLTIX 


THE  ANN PAL  CATALOGUE  FOB  SESSION. 
1909-10. 

The  annua]  catalogue  recently  issued  by  the 
I  »can  of  the  Faculty  of  Physic  of  the  University 
of  Maryland  presents  a  general  statement  of  the 
work  in  the  Medical  Department  during  the  past 
session  and  an  announcement  of  the  course  for  the 
coining  session. 

Whilst  few  changes  have  been  made  in  the  work 
proposed,  the  report  for  the  past  session  shows 
many  evidences  of  progress. 

During  the  session  there  were  329  medical  stu- 
dents in  attendance,  of  which  number  89  received 
the  degree  of  Doctor  of  Medicine.  Forty  raem- 
bers  of  the  present  fourth  year  class  were  ap- 
pointed clinical  assistants  to  the  Fni  versify  -Hos- 
pital. The  Hospieal  staff  now  numbers  fourteen 
assistant  resident  physicians,  surgeons,  obstetri- 
cians and  pathologists.  The  Training  School  for 
Nurses  numbers  64.  During  the  year  1908-1909 
4,947  patients  were  treated  in  the  University  Hos- 
pital, while  in  the  outdoor  department  31,423 
patients  were  treated.  This  rich  field  of  clinical 
material  was  used  in  the  clinical  instruction  of  the 
students  in  attendance. 

In  the  Maternity  Hospital  of  the  University 
235  indoor  confinements  were  attended  and  448 
outdoor,  a  total  of  683  cases,  making  an  average 
of  33  cast's  of  labor  seen  by  each  student  of  the 
graduating  class.  In  addition  to  the  above  the 
students  of  the  graduating  class  received  instruc- 
tion in  Bayview  Hospital,  Hospital  for  the  Belief 
of  Crippled  and  Deformed  Children  and  Presby- 
terian Eye  and  Ear  Hospital. 

The  Bulletin  doubts  whether  any  medical 
school  in  this  country  can  offer  to  its  graduating 
class  larger  or  better  facilities  for  clinical  work 
and  instruction  than  the  University  of  Maryland. 
In  this  field  she  stands  ready  to  show  results  or 
to  institute  comparisons.  The  future  of  the  Uni- 
versity was  never  more  encouraging  than  it  is  to- 
day. Her  plant  and  organization  arc  keeping 
pace  with  every  requirement  of  a  great  clinical 
school.  The  spirit  of  harmony  and  progress  is 
the  spirit  of  her  teaching  and  student  bodies.  All 
are  striving  to  do  efficient  work  in  imparting  and 
in  receiving  instruction.  These  statements  are  not 
made  in  a  boastful  spirit,  but  with  an  honest  desire 
to  assure  the  alumni  of  the  University  who  have 
few  opportunities  of  visiting  their  old  Alma  Mater 
just  what  she  is  doing  and  how  far  she  is  making 


good    bar   claims    upon    them    for    respect    anil    co- 
operation in  her  work. 


CORRESPONDENCE 


Santiago  de   los   Caballekos, 

Rkpublica    Dominicana, 

July   1,   1909. 
Deah  Mi;.  Editor: 

Piesuming  that  you  might  have  a  small  corner 
in  your  interesting  little  Bulletin,  I  am  send- 
ing you  a  report  of  one  of  several  cases  of  "Te- 
tanus." that  has  recently  fallen  to  my  lot,  and 
that  may  prove  of  interest  to  your  readers. 

Tetanus  is  very  prevalent  in  this  country  and 
as  in  all  countries  has  a  high  mortality,  the 
treatment  only  makes  us  realize  how  little  we 
can  accomplish.  My  own  experience  with  the 
serum  as  a  curative  measure  has  been  anything 
I  nit  encouraging.  Perhaps  the  serum  supplied 
has  been  at  fault.  Certainly  the  conditions  in 
the  tropics  are  not  favorable  to  its  preservation 
for  any  length  of  time.  Some  months  ago  I  had 
heard  or  read  of  the  use  of  sulphur  in  Tetanus, 
and  resolved  to  try  it.  Since  using  this  drug 
1  have  had  five  good  cases  to  attend,  three  of 
which  are  still  alive;  in  the  other  two  cases  the 
patient  had  been  neglected  until  too  late  to  de- 
rive any  benefit  from  any  treatment.  I  will  cite 
one  of  my  successful  cases.  On  Feb.  12,  1909, 
I  was  called  from  Santiago  to  Laguna  Salada,  a 
distance  of  45  miles,  to  see  a  young  man  with 
"spasm."  On  arrival  I  found  the  patient  sur- 
rounded by  several  friends,  struggling  fearfully. 
Gradually  1  got  the  history  of  a  cut  foot  following 
a  bath  in  the  river.  ■  Ten  or  twelve  days  later  began 
to  have  attacks,  gradually  growing  in  violence 
until  at  the  time  of  my  arrival  the  attacks  were 
about  every  twenty  minutes  and  very  violent.  All 
the  muscles  of  the  body  involved,  and  the  patient 
during  the  attacks  very  violent,  it  being  neces- 
sary for  two  or  three  men  to  control  him.  His 
anus  especially  were  involved  and  the  set  of  the 
jaw  muscles  gave  the  characteristic  "Risus  Sar- 
donicus."  After  each  spasm  the  poor  fellow 
would  show  how  completely  exhausted  he  was. 
Although  the  spasm  was  over,  his  muscles  still 
retained  some  rigidity  and  he  perspired  profusely. 
He  had  one  degree  of  temp.  In  these  countries 
when  a  man's  inipedinieiitcT  is  crowded  in  his 
saddle  hags,  the  opportunity  to  confirm  one's 
diagnosis  microscopically  is  denied  you.     But  hav- 


THE  HOSPITAL  BULLETIN 


113 


Lng  eeen  so  much  of  this  condition,  I  feel  sure 
of  the  diagnosis.  I  immediately  confiscated  all 
the  "Mauteea,"  or  Dative  butter  in  the  hut.  and 
roughly  made  up  with  5ii  °f  sulphur  precipi- 
tate and  Vt>  a  lb.  more  or  less  of  butter  an  oint- 
ment, and  picking  out  two  strong  young  men 
staited  them  to  work  rubbing  the  ointment  into 
the  chest,  abdomen,  loins,  groin  and  axillae;  as 
these  fellows  tired  two  others  continued  the  rub- 
bing, lesting  only  at  the  spasm.  Every  two  bonis 
1  gave  one  teaspoonful  of  sulphur  precipitate  in 
a   little  milk,   by   mouth.     Leaving  my  directions 

thus,    I    slung    my    ha lock    in    a    neighboring 

booeja,  I  slept  for  four  hours.  On  awaking  I 
was  informed  that  the  attacks  had  been  less  fre- 
quent  and  weaker,  lasting  a  much  shorter  time. 
This  treatment  was  kept  up  for  fifteen  hours,  at 
the  end  of  which  time  he  bad  passed  three  bonis 
without  attack.  His  body  muscles  were  almost 
completely  relaxed  and  he  was  dozing  comforta- 
bly. The  last  attack  had  been  very  feeble.  I 
reduced  my  treatment.  5i  Prec-  sulphur  every 
four  hours,  in  milk  and  left  him.  His  recovery, 
I  was  later  informed,  was  rapid — in  several  days 
he  was  up  and  out. 

This  is  one  of  three  cases  treated  with  sulphur. 
The  two  fatal  cases  I  mentioned  had  been  for 
days  without  treatment  (except  the  native  witch 
doctor),  and  were  not  fair  cases. 

Chahles  Haddwick.  M.  D., 

Class  of   19(14. 


THE  OPENING  OF  THE  GENERAL  AND 

MARINE  HOSPITAL  AT  C'RIS- 

FIELD,    MARYLAND. 

Ckisfikld,  Md.,  June  30th,  1909. 
To  The  Hospital  Bulletin  : 

Crisfield  is  the  southernmost  town  of  any  con- 
siderable size  in  the  State  of  Maryland.  Its  popu- 
lation is  approximately  5,000  people,  and  there  is 
perhaps  another  5,000  within  an  area  of  5  miles. 
It  is  a  port,  of  entry  of  the  United  States  ami  it 
is  said  that  the  number  of  vessels  registered  at  this 
port  is  exceeded  hut  by  two  or  three  other  ports 
in  the  country.  Although  it  lias  a  large  number 
of  vessels,  they  are  of  small  size  and  light  tonnage. 
The  chief  industries  are  connected  with  the  water 
and  consist  of  crabbing  in  the  summer  and  oyster- 
ing  in  the  winter.  It  is  said  to  be  the  largest 
crab  market  in  the  world.  Owing  to  these  in- 
dustries a  large  number  of  men  are  employed  who 


come  from  all  parts  of  the  country,  and  until  the 
present  time  there  has  been  no  adequate  provision 
for  the  care  of  these  people  when  sick  and  injured, 
and  hitherto  they  have  been  treated  at  their  homes 
by  the  local  physicians  or  sent  to  Baltimore  or  to 
other  cities  where  hospitals  are  located. 

Today  is  a  red  letter  day  in  the  history  of  Cris- 
lield  for  it  marks  the  fruition  of  plans  that  have 
long  been  in  preparation  for  the  establishment  of  a 
hospital  in  this  city.  The  General  and  Marine 
Hospital  was  dedicated  today  and  will  soon  be 
opened  for  the  reception  of  patients.  The  Hos- 
pital will  he  under  the  professional  care  of  the 
physicians  of  Crisfield  and  id'  Somerset  county,  but 
a  staff  of  consulting  physicians  and  surgeons  from 
Baltimore  wall  assist  them  in  their  work. 

In  company  with  Drs.  J.  Fred.  Adams,  .1.  M. 
Craighill  and  Nathan  Winslow,  1  attended  the 
opening  ceremonies  of  the  Hospital.  A  large  com- 
pany  was  present  from  the  town  and  surrounding 
country  as  well  as  from  nunc  remote  points  ami 
the  board  of  lady  managers  served  an  elaborate 
entertainment  for  those  who  were  present.  Or. 
Gordon  '1'.  Atkinson  presided  ami  introduced  the 
speakers.  The  Governors  of  Virginia  and  Mary- 
land were  both  expected  to  he  present,  but  neither 
of  them  put  in  an  appearance,  consequently  their 
places  in  the  program  had  to  lie  filled  by  others. 
and  I  believe  I  was  the  substitute  for  the  Governor 
of  Maryland.  In  fact,  it  seemed  to  lie  my  lot  to 
he  mistaken  for  the  Governor,  as  when  Dr.  Craig- 
hill ami  I  walked  up  the  street  at  Crisfield,  we 
met  an  elderly  man  leading  a  brindled  bull  dog, 
named  Mike,  who  inquired:  "Is  any  one  of  you 
gentlemen  the  Governor?"  Perhaps,  however,  he 
thought  Dr.  Craighill,  with  his  dignified  manner 
and  impressive  bearing  to  fie  the  Governor,  and  I 
only  the  Secretary  of  State? 

The  Hospital  is  situated  on  the  main  street  of 
the  city  and  consists  of  a  two-story  building  which 
is  very  well  adapted  for  the  purposes  to  which  it  is 
devoted.  It  will  have  accommodation  for  aboul 
".-(>  patients  and  has  been  well  furnished  with  beds 
and  other  necessary  fixtures  as  well  as  with  the 
necessary  equipment  of  a  modern  operating  room. 
Crisfield  is  to  be  congratulated  upon  having  this 
institution  for  the  care  of  its  sick  and  suffering, 
for  not  only  will  it  he  a  boon  to  those  who  seek 
entrance  into  its  wards,  but  it  will  also  be  a  greal 
educational  factor  in  the  training  of  the  physician's 
id'  the  town  and  county,  as  well  as  a  center  from 
which  important  hygienic  and  sanitary  informa- 
tion will  be  disseminated  amongst  the  people. 


114 


T 


HOSPITAL  BULLETIN' 


As  in  other  portions  of  the  Eastern  Shore,  hos- 
pitality reigns  supreme,  and  during  our  stay  in  the 
town  every  possible  courtesy  and  attention  was 
shown  us.  Crisfield  may  be  reached  by  steamboat, 
leaving  Baltimore  about  5  o'clock  in  the  afternoon 
and  reaching  Crisfield  very  early  in  the  morning. 
The  trip  down  the  bay  is  very  pleasant  and  i  n  j  \ 
able,  luit  the  early  hour  at  which  one  is  obliged  to 
disembark  is  far  from  agreeable;  or  one  may  take 
the  train  at  Union  Station  and  changing  to  the 
Delaware  Railroad  may.  by  a  circuitous  route, 
reach  Crisfield  in  five  or  six  hours.  It  is.  however, 
a  much  more  pleasant  trip  to  go  by  steamboat.  At 
the  time  of  our  arrival  the  boatmen  were  beginning 
ti'  go  but  in  their  boats  to  their  daily  work.  These 
boats  going  out  in  large  numbers  present  a  verj 
beautiful  and  interesting  sight  and  with  their  sails 
spread  resemble  hocks  of  huge  birds  skimming  over 
the  sin  face  of  the  water.  They  come  hack  laden 
with  crabs,  or  oysters,  or  other  sea  game.  Another 
very  peculiar  and  interesting  industry  is  that  of 
raising  terrapins  for  the  market.  One  terrapin 
pond  which  we  visited  was  tilled  with  thousands  nf 
diamond  hack-  and  other  varieties  of  terrapin. 
These  terrapins  are  exported  to  New  York  and 
other  large  cities  and  arc  sold  at  high  pi  ices  to 
the  Famous  hotels  and  restaurants  of  these  centres. 
Diamond  hack  terrapins  seven  inches  in  length  sell 
for  $3  apiece,  whilst  those  eight  inches  in  length 
bring  $100  a  dozen.  They  are  caught  by  hunts- 
men, who  sell  them  to  the  owner  of  the  pond,  who 
keeps  them  until  they  are  lit  l"r  the  market. 
There  is  an  obsolete  law  which  prohibits  Feeding 

slaves  on  dia nd  hack  terrapin  oftener  than  twice 

.•  day. 

The  University  of  Maryland  is  well  represented 
at  Crisfield  by  its  medical  graduates,  Drs.  ('.  E. 
Collins,  W.  II.  ('.illumine.  Win.  F.  Hall.  G.  T. 
Simouson  and  .1.  F.  Somers,  who  are  all  estab- 
lished in  extensive  practice,  and  by  Dr.  R  1!. 
Xoriis.  lately  of  Baltimore,  who  has  verj  recently 
removed  to  Crisfield. 

Randolph  Winslow. 


ITEMS. 


Doctor  Nathan  Winslow,  class  of  1901,  of  Bal- 
timore, has  left  for  Richmond,  where  he  will  visit 
points  of  interest. 


residence  of  a  year  in  the  interior  of  Brazil,  where 
he  has  been  engaged  in  the  practice  of  his  pro- 
fession. In  three  months'  time  he  expects  to  re- 
turn  to  Brazil. 


Doctor  Edson  W.  Glidden,  Jr.,  class  of  1907, 
nf  Savannah.  Ga.,  and  formerly  a  resident  physi- 
cian in  the  University  Hospital,  has  been  spend- 
ing a  few  days  in  Baltimore  visiting  the  Uni- 
versity Hospital. 


Doctor  St.  (lair  Spruill  has  been  elected  assist- 
ant surgeon  to  St.  Agnes'  Hospital.  Baltimore,  and 
Doctor  John   T.   O'Mara  has  been  appointed  his 

assistant. 


Doctor  John  Wilson  MacConnell,  class  of  1907, 
of  North  Carolina,  recently  visited  the  University 
Hospital,  Amongst  other  visitors  may  lie  men- 
tioned Dr.  Washington  Claude,  class  of  1ST."),  of 
Annapolis.  Md.,  and  Iiul'us  Cecil  Franklin,  class 
of  l!tt>7.  ,,f  Georgia. 


Doctor  and  Mrs.  William  Hewson  Baltzel,  of 
Boston,  aie  spending  a  frw  days  at  the  Hotel 
Belvedei  e.  Baltimore. 


Doctor  William  Emrich,  class  of  1902,  of  Bal- 
timore, has   returned   to   his   native  city   after  a 


Doctor  Harry  Young  Righton,  class  of  1907,  of 
Savannah,  Ga„  is  visiting  friends  in  Baltimore. 
After  the  completion  of  his  course  at  the  Uni- 
versity of  Maryland  he  was  resident  physician  at 
St.  Joseph's  Hospital.  Baltimore,  for  a  year. 

Dr.  T.  A.  Ashby,  of  the  Faculty  of  Physic,  has 
been  nominated  by  the  Democratic  party  as  one 
of  its  candidates  for  the  Legislature,  from  the 
Third  District  of  Baltimore  city.  The  nomina- 
tion came  to  Dr.  Achby  unsolicited,  and  he  was 
induced  to  accept  it  against  his  personal  interests 
as  a  duty  which  he  believed  he  owed  the  medical 
profession  and  people  of  the  State. 

Dr.  Ashby  is  the  only  physician  in  the  city  dele- 
gation and  will  lie  in  a  position  to  render  a  most 
eilicient  service  in  trying  to  procure  the  passage  of 
laws  which  will  improve  the  health,  comfort  and 
educational  interests  of  out  people. 

If  elected  he  will  go  to  Annapolis  with  the 
sole  purpose  of  trying  to  use  his  influence  and 
ability  I'm-  the  general  uplift  of  all  classes  of  Legis- 
lation. His  long  training  as  a  practitioner  of 
medicine,  teacher  and  editor,  and  his  large  ac- 
quaintance  with   physicians   throughout   the   State 


THE   HOSPITAL  BULLETIN  115 

ami  with  public  officials  will  be  of  greai   service         Dr.  Samuel  Theobald  lias  returned  to  his  home 
to  him  as  a  member  of  the  Legislature.  limn  a  visit  in  New  London,  Conn. 


After  baving  a  haul  fight  against  <lratli   Dr.  A.  The  Baltimore  County  Medical  Society  met  at 

L.  Wilkinson,  Cole  avenue  and  Belair  ro,ad,  ltaspe-  Springfield    Hospital,   Sykesvijle,   July    15,    1909. 

burg,    is  now   able  to  attend   to   his   professional  After    luncheon     Dr.    .1.     Clement    Clark,    class 

duties  again.  

of  issi.  superintendent  of  the  hospital,  showed  the 

Doctor  ami  Mis.  Henry  B.  Thomas  have  closed  visitors  over  the  institution  in  company  with  the 

their  house  at  Catonsville  ami  are  spending  July  city  grand  jury.     The  members'  of  the  society  ex- 

aml  August  at  Blue  Ridge  Summit.  Pa.  pressed   themselves  pleased   with   the  management 

of  the  hospital  ami  its  methods.     The  society  was 

Doctor    .1.    Clement    (lark,    class    of    1861,    of  addressed    by    Dr.    (lark.       Among  those   present 

Sykesville,  Md..  is  spending  the  summer  at  Ocean  «'ere:     Drs.  John   Winslow,  M.  (i.   Porter,  F.  J. 

City,  Mil.  Kiihy.  Heniy  A.  Xavlor.  II.  Louis  Xavlor,  Josiab 

S.  Bowen,  A.  D.  McConachie,  J.  P.  II.  Gorsuch, 

Doctor  and   Mrs.   Frank   Chisolm,  of   Washing-  Frank  J"   Keating- 


ton,   formerly  of  Baltimore,  left  recently   for  the 

Berkshire  Hills,  where  they  will  spend  their  sum-  Doctor  W.  F.  Wiegand  and  family  have  gone  to 

mer  vacation.  Asbury   Park,  New  Jersey,  for  the  summer. 


Doctor  H.  W.  Wickes,  passed  assistant  surgeon,  Dr.  and   Mrs.  (J.   \\".    Dobbin  have  closed  their 

United  States  Public  Health  and  Marine  Hospital  town   house  and   taken   a   house  on   Charles  street, 

Service,  has  been  granted   one   month's   leave  of  extended,  for  the  summer, 

absence  from  August  1.  1909..  

Dr.   R.   B.  Warlielil   has  left   for  a  six  weeks'  stay 

Dr.  Eugene  H.  Mullan,  passed  assistant  surgeon  in  Europe. 

of   the   same   service,   has   been   granted    two   days'  

leave  of  absence  from  July  12,  1909.  Dr.   C.   F.   McElfresh  and    family   have  left   for 

Fairmont,  West  Virginia,  where  they  expect  to  stay 

Doctor  and  Mrs.  James  M.   Craighill  have  left  '"lm'  tni"  ■ 

for  Canada,  where  they  will  spend  a  month  at   the  .         

various  places  of  interest!  Dr.  Hiram  Woods  has  returned  from  New  Lon- 
don.  Conn. 

Doctor  Martin  J.  Hanna,  a  graduate  of  Sewanee 

University,  hut  formerly  a  member  of  the  class  of  Dr.   and   Mrs.    Frank  Crouch  are    in   the   White 

1908,  was  married  recently  to  Miss  Sarah  S.  Fust,  Mountains,    where    they    expect    to    remain    several 

at  the  home  of  the  bride,  113  North  Fremont  ave-  weeks. 
nue.     Upon  their  return  from  a  honeymoon,  spent 

in  the  North,  Dr.  and  Mrs.  Hanna  will  reside  at  Dr.   Prank  Martin  will  spend  the  late  summer 

■.'."> 7   Xorth  Fulton  avenue,  Baltimore.  in  Europe. 


Doctor  John   S.   Fulton   has  sailed    for   Europe          Dr.  and  Mrs.  J.  William  Funk  are  spending  the 
where  he  will  spend  the  remainder  of  the  summer     summer  at  Ocean  City,  Md. 
traveling.  

Dr.  Silas  Baldwin  has  almost  recovered  from  the 
Doctor  T.  C.   Gilchrist  has  sailed    for  Europe      recent  driving  accident  in  Druid  Hill  Park, 
where  he  will  visit  [mints  of  interest. 


Dr.  Allan  Walker,  class  of  1886,  of  Washington, 

Dr.  and   Mrs.    Irving  Miller  are  summering  in      D.  ('..  recently  paid   the  hospital  a  visit  where  he 
•Maine.  renewed  old  acquaintances. 


116 


THE  HOSPITAL  BULLETIN 


Professor  Charles  Wellman  Mitchell,  one  of 
the  regents  and  formerly  dean  of  the  medical  de- 
partment of  the  University  of  Maryland,  recently 
appointed  to  the  vacancy  in  the  chair  of  medicine 
caused  by  the  recent  resignation  of  Professor  Sam- 
uel ('.  Chew,  is  a  native  of  Baltimore  and  for  some 
years  has  held  the  chairs  of  Diseases  of  Children. 
Therapeutics  and  Clinical  Medicine  in  the  Medical 


Faculty,  the  latter  two  of  which  lie  now  relin- 
quishes. He  received  the  degree  of  Bachelor  of 
Arts  at  Princeton  in  1879,  and  afterwards  the  de- 
gree of  Master  of  Arts. 


Doctor  Arthur  M.  Shipley,  associate  professor 
of  surgery,  has  been  made  professor  of  therapeutics 
and  surgical  pathology  and  a  member  of  the  Board 
of  Regents.  Dr.  Shipley,  who  is  from  Anne 
Arundel  county,  was  honor  man  of  the  class  of 
1902.  After  graduation  he  was  appointed  assist- 
ant resident  surgeon  to  the  University  Hospital,  a 
position  he  held  two  years,  then  was  promoted  to 
the  superintendency  of  the  University  Hospital 
where  he  remained  until  June,  1908,  when  he  en- 
tered upon  the  practice  of  surgery  in  the  city  of 
Baltimore. 


Doctor  A.  Duvall  Atkinson  has  resigned  his 
clinical  professorship  of  medicine.  He  and  his 
wife  will  spend  the  summer  touring  Europe. 


Under  the  caption  of  leading  men  of  Maryland 
the  Baltimore  Star  presenting  his  portrait  has 
this  to  say  concerning  Doctor  Joshua  W.  Hering. 
class  of  1855 : 

"Dr.  Joshua  W.  Hering,  who  in  December  will 
end  his  third  term  as  State  comptroller,  and  who 
will  be  renominated  for  a  fourth  term  at  the 
coming  Democratic  State  Convention  on  August 
11,  1909,  is  probably  the  most  popular  man  today 
in  the  Democratic  party  in  Maryland.  Besides 
being  a  physician  and  State  comptroller,  Dr.  Her- 
ing is  a  hanker.  His  home  is  at  Westminster.  Be- 
fore his  election  as  State  comptroller,  in  1899,  he 
had  served  two  years  in  the  State  Senate.  In 
point  of  age  and  public  service,  Dr.  Hering  may 
be  called  the  grand  old  man  of  the  Democratic 
party.      He  has  passed  his  seventieth  milestone." 


Doctor  Elijah  Miller  Reid,  class  of  1864,  late 
professor  of  diseases  of  the  nervous  system  and 
of  the  throat  and  chest, '  Baltimore  University 
School  of  Medicine,  is  a  prominent  practitioner  of 


the  city  of  Baltimore.  He  is  a  native  of  Ohio, 
bom  near  Lancaster,  Fairfield  County,  November 
15,  IS  14,  and  is  a  son  of  Thomas  N.  and  Keturah 
(Miller)  Reid.  His  elementary  education  was  ac- 
quired  iir  the  schools  of  Baltimore.  At  sixteen 
years  of  age  he  entered  the  medical  department  of 
the  University  of  Maryland  from  whence  he  was 
graduated  in  1864.  For  a  few  months  following 
his  graduation  he  practiced  medicine,  then  having 
passed  the  examination  of  the  Army  Medical 
Board,  he  entered  the  United  States  Army  as  an 
acting  assistant  surgeon,  and  was  assigned  to  Co- 
lumbia College  Hospital,  and  later  was  stationed  at 
Armory  Square  and  Lincoln  Hospital,  Washing- 
ton, 1).  C. 

After  his  service  in  the  amrv.  Dr.  Reid  estab- 
lished himself  on  the  Reisterstown  road,  in  Balti- 
more  county.  In  1869  he  returned  to  the  city  of 
Baltimore,  where  be  has  since  resided.  In  1888 
he  accepted  the  chair  of  physiology,  hygiene  and 
diseases  of  the  throat  and  chest  in  Balitmore  Uni- 
versity School  of  Medicine,  in  which  chair  he  re- 
mained until  1892,  when  he  was  transferred  to 
the  chair  of  diseases  of  the  nervous  system  and 
the  throat  and  chest.  In  1906  he  resigned  his 
professorship.  In  1887-88  he  was  chairman  of  the 
section  on  medical  jurisprudence  of  the  American 
Medical  Association.  Doctor  Beid  married  No- 
vember 9,  1887,  Mary  A.  Allen,  daughter  of  John 
Allen,  of  Baltimore.  Four  children  were  begotten 
by  this  union,  all  of  whom  are  now  dead. 


Doctor  Wirt  Adams  Duvall,  of  Baltimore,  class 
of  1888,  was  born  in  Anne  Arundel  county,  Mary- 
land, October  21,  1863.  His  elementary  education 
was  acquired  in  the  public  schools,  and  in  St. 
John's  College,  department  of  Arts  and  Sciences, 
University  of  Maryland.  In  1895  he  received  from 
his  alma  mater  his  M.  A.  degree.  After  leaving 
fol lege  he  matriculated  in  the  medical  department 
of  the  LTniversity  of  Maryland  where  he  received 
his  medical  degree  with  the  class  of  1888.  From  i 
1890-92  he  served  as  city  vaccine  physician,  assist- 
anl  demonstrator  of  anatomy.  University  of  Mary- 
land, 1889-90;  demonstrator  of  osteology,  Balti- 
more Medical  College,  1893-95;  demonstrator  of 
osteology.  University  of  Maryland,  1897-98. 


General  Thomas  Andrew  McParlin,  United 
States  Army,  class  of  1847,  was  born  at  Annapolis, 
July  10,  1825,  and  died  in  the  house  in  which  he 
was  born,  January  28,  1897.  His  parents  were 
William    McParlin   and   Cassandra   Hillary   Beall 


THE  HOSPITAL  BULLETIN 


117 


Woodward.  His  father  was  an  officer  in  the  war 
of  1812.  He  received  his  literary  education  at  St. 
John's  College,  Annapolis,  now  department  of  arts 
and  sciences  of  the  University  of  Maryland,  gradu- 
ating with  the  degree  of  B.  A.  in  18  L4.  He  gradu- 
ated from  the  University  of  Maiyland  medical  de- 
partment in  1847,  and  immediately  entered  the 
medical  corps  of  the  United  States  Army.  He 
served  in  the  Mexican  War  in  1848,  in  the  Semi- 
nole War  in  1856-57,  and  through  the  Civil  War. 
He  was  medical  director  of  General  Grant's  Army 
in  the  Richmond  campaign.  In  1866,  at  the 
recommendation  of  General  Phil.  Sheridan,  he  was 
brevettcd  brigadier  general  for  meritorious  service. 
In  1858  Dr.  MeParlin  married  Miss  Alida  Yates 
Leavenworth  Roca,  by  whom  he  had  four  children. 
Alida.  now  wife  of  Senor  Don  Manuel  Klguera,  of 
Lima,  Peru  ;  Agnes  Cassandra;  Harriet  Clare,  wife 
of  Dr.  Michael  J.  Sullivan,  of  Englewood,  X.  J., 
and  Eleanor  Beall,  wife  of  Dr.  Isaac  II.  E.  Davis, 
of  Baltimore,  Md. 


Doctor  Henry  Merryman  Wilson,  a  general  prac- 
titioner of  medicine  in  Baltimore  for  more  than 
fifty-seven  years,  ex-president  of  the  Medical  ami 
Chiiurgical  Faculty  and  in  many  other  ways  prom- 
inently identified  with  the  professional  life  of  the 
city  and  one  of  our  distinguished  alumni,  was  born 
in  Baltimore,  February  2,  1S-.J'J.  son  of  Luther 
Wilson  ami  Achsah  Merryman,  his  wife.  His 
early  education  was  acquired  under  private  in- 
struction and  his  collegiate  at  Dickinson  College, 
Carlisle,  Pa.,  where  in  1848  he  received  the  degree 
of  B.  A.  He  was  educated  in  medicine  in  the  de- 
partment of  medicine.  University  of  Maryland, 
graduating  from  there  in  1851.  Since  that  time 
he  has  been  a  prominent  figure  in  the  professional 
circles  in  the  city  of  Baltimore.  He  became  a 
member  of  the  Medical  and  Chirurgical  Faculty  in 
1853,  of  which  body  he  was  secretary  from  1850  to 
1873,  vice-president  in  1873-7-1,  and  president  in 
1874-75.  In  1886-87  he  was  president  of  the 
Alumni  Association  (Medical)  of  the  U/niversity  of 
Maryland.  He  is  a  trustee  of  Dickinson  College, 
and  of  the  Woman's  College,  Baltimore.  On  Octo- 
ber 7,  1851,  Dr.  Wilson  married  Eliza  Kelso  Hil- 
lingsworth.  Their  children  are :  John  Kelso, 
Anna  Ward,  Luther  Barton,  Maude  Hollingsworth 
and  Henry  Merryman  Wilson,  Jr. 


Lege,  was  born  in  Baltimore  on  the  30th  of  June, 
1868.  His  eaily  education  was  obtained  at  Milton 
Academy  ami  Marston's  University  School  for 
Boys  and  his  Collegiate  in  the  Academic  Depart- 
ment of  the  John  Hopkins  University.  He  was 
educated  for  the  profession  of  medicine  at  the  Uni- 
versity of  Maryland,  graduating  with  the  class  of 
1888.  Since  graduating  Dr.  Horn  has  been  en- 
gaged in  the  practice  of  medicine  in  Baltimore  and 
at  various  times  has  held  the  positions  of  city 
vaccine  physician,  police  surgeon  and  physician  to 
the  Augsburg  Home  for  the  Aged.  In  1891  he 
was  elected  a  member  of  the  Medical  and  Chirurgi- 
cal  Faculty. 


Thomas  Melville  Talbott,  class  of  1S?(),  a  native 
of  Palls  Cbuich,  Fairfax  county,  Va.,  ex-president 
of  the  Fairfax  County  Medical  Society,  and  a  gen- 
era] practitioner  of  medicine  of  more  than  thirty- 
five  years,  was  horn  near  White's  Ferry,  in  Mont- 
gomery county.  Va.,  on  the  17th  of  October,  1818. 
He  is  a  son  of  Benson  and  Maiia  Hyde  Talbott. 
lie  was  educated  in  the  public  schools  of  Mont- 
gomery county.  In  1868  he  entered  the  medical 
department  id'  the  University  of  Maryland,  whence 
he  graduated  in  1870.  During  his  senior  semestre 
he  was  a  resident  student  in  the  University  Hos- 
pital. Dr.  Talbott  began  his  professional  career- 
in  Baltimore,  but  soon  afterwards  moved  to  George- 
town, where  he  only  practiced  a  few  months,  re- 
moving from  thence  to  Falls  Church,  Va.,  where 
he  is  still,  located.  He  is  a  member  of  the  Vir- 
ginia State  Medical  Society. 

In  1876  he  married  Miss  Ella  Febrey,  who  died, 
leaving  one  son.  Dr.  Edward  M.  Talbott,  assistant 
surgeon  United  States  Army.  In  1892  Dr.  Tal- 
bott married  Miss  Kathleen  Nburse,  by  whom  he 
has  three  children,  Philip  M.,  Harold  W.  and 
Kathleen  Talbott. 


Doctor  August  Horn,  class  of  1888,  formerly 
associate  professor  of  dermatology  and  diseases  of 
children  in  the  Baltimore  University  Medical  Col- 


Doctor  Joseph  Smith  Horner,  class  of  1883,  of 
Hot  Springs,  Ark.,  who  has  been  a  resident  physi- 
cian and  surgeon  of  that  place  for  the  past  twenty 
years,  is  a  native  of  Missouri,  ami  was  born  in 
Fornersville,  September  10,  1858.  He  is  a  son 
of  Dr.  William  Hicks  and  Margaret  Elizabeth 
(Smith)  Horner.  His  early  education  was  re- 
ceived in  public  schools  and  his  higher  education 
in  Arcadia  College,  at  Arcadia,  Mo.,  Colorado  Col- 
lege, at  ('(dorado  Springs,  and  the  University  of 
Illinois,  where  he  was  a  student  in  1876-1877.  At 
the  beginning  of  the  session  of  1881  he  matricu- 


118 


THE  HOSPITAL  HL'LLHTIN" 


lated  in  the  medical  department  of  the  University 
of  Maryland  and  graduated  with  tire  degree  of 
Doctor  of  Medicine  in  1883.  During  his  senior 
year  Dr.  Horner  Eerved  as  an  interne  at  the  Uni- 
versity Hospital.  After  entering  general  practice 
lie  attended  Eor  a  time  as  a  graduate  student  the 
St.  Louis  Polyclinic.  In  July,  1888,  lie  removed 
from  Bloomfieldj  Mo.,  where  he  had  been  prac- 
ticing for  five  years  and  Located  in  lint  Springs, 
where  he  has  since  been  engaged  in  the  practice 
of  medicine,  He  is  a  member  of  various  profes- 
sional organizations,  among  them  being  the  Hot 
Springs-Garland  County  Medical  Society,  Ar- 
kansas State  Medical  Society,  and  the  American 
Medical  Association.  He  is  a  Mason,  Knights 
Templar,  a  member  of  the  Benevolent  and  Pro- 
tective Order  of  Elks,  ami  of  the  Presbyterian 
( 'hui eh. 

On  June  '.',  1884,  Dr.  Homer  married  Miss 
Alice  Bell  Buck,  by  whom  he  has  five  children, 
Margaret  Elizabeth,  Carl  Horner,  deceased;  Helen 
Edith,  Frances  and  William  Lawrence  Horner. 


Doctor  William  Christian  Sandrock,  class  of 
1878,  of  Baltimore,  former  vice-presiden.i  of  the 
Adams  County  Medical  Society,  and  former  presi- 
dent of  the  New  Oxford  School  Board,  both  Penn- 
sylvania Institutions,  was  born  in  Baltimore,  Octo- 
ber 2,  1854.  Having  received  his  literary  educa- 
tion in  the  public  schools  and  Knapp's  Institute, 
he  entered  Maryland  College  of  Pharmacy,  now 
the  department  of  Pharmacy  of  the  University  of 
.Maryland,  whein-e  he  was  graduated  with  the  de- 
gree of  Ph.G.  in  1875.  He  then  matriculated 
in  the  medical  department  of  the  I  adversity  of 
Maryland  and  graduated  from  there  with  the  de- 
gree of  Doctor  of  Medicine  in  1878.  Doctor 
Sandrock  immediately  after  graduation  entered 
upon  the  practice  of  medicine  in  Adams  county, 
Pennsylvania. 


In  1889  he  returned  to  Baltimore  and  has  since 
practiced  in  this  city.  In  1890  he  became  a  mem- 
ber of  the  Medical  and  CKirurgical  Faculty. 


In  your  notices  of  marriage  you  might  add  that 
of  Dr.  Jolin  1'.  Young,  of  Richburg,  S.  ('.,  to  Miss 
Constance  Witherspoon,  of  Lancaster.  S.  ('..  on 
June  23rd,   1909,." 

Tin:  Bulletin  congratulates  Dr.  Young  and 
wishes  him  much  happiness  and  success  in  life. 

Through  an  unfortunate  oversight  on  the  part 
of  the  printer,  the  Closing  sentences  of  Prof. 
Chew's  paper  published  in  the  duly  15th  number 
of  The  Bulletin  were  omitted.  They  are  here- 
with presented : 

There  is  however  one  special  case,  and  a  very 
serious  one,  too,  with  which  physicians  are  not  in- 
frequently confronted;  it  is  the  knowledge  of  the 
existence  of  specific  disease  in  one  who*  is  or  has 
been  recently  under  the  physician's  care,  and  who 
is  contemplating  marriage  within  the  time  in  which 
it  would  be  improper.  In  such  a  case,  if  the 
warning  counsel  of  the  physician  with  a  pure 
statement  of  what  may  be  the  consequences  should 
In  disregarded,  so  that  misery  and  wretchedness. 
corruption  of  body  and  ruin  of  mind  may  be  im- 
pending over  an  innocent  person,  the  parents  or 
other  friends  of  the  one  endangered  should  be  in- 
formed, for  otherwise  the  physician  could  be  justly 
regarded  as  an  accessory  heroic  the  fact  with 
guilty  knowledge.  I  have  endeavored  to  give  some 
illustrations  of  what  should  be  our  ethical  course 
of  action  in  varying  cases,  and  I  may  say  in  con- 
clusion that  the  best  ethical  guide  in  all  cases  and 
under  any  circumstance's  may  be  found  in  these 
woids  from  the  Divinist  lips:  "All  things  what- 
soever ye  would  that  men  should  do  to  you.  do 
ye  even  so  to  them." 


Dr.  J.  P.  Young,  of  Richburg,  S.  ('..  writes. 
"The  Bulletin  is  always  a  welcome  visitor  to  my 
home,  ami  I  wish  for  it  a  long  life  and  increasing 
usefulness. 


DEATHS, 

Doctor  William  II.  Whitehead,  class  of  1870,  of 
■Rocky  Mount,  X.  ('..  died  in  Raleigh,  June  25, 
1909,  of  paresis.  In  Ins  .hath  the  State  of  North 
Carolina  has  lost  one  of  her  best  citizens  and  the 
medical  profession  an  honored  member.  Doctor 
Whitehead  has  held  many  places  of  honor  and 
tiust.  He  was  at  the  time  of  his  death,  an  hon- 
orary fellow  of  the  North  Carolina  State  Medical 
Society.  From  1890  to  ism;  he  was  a  member 
ami  president  of  the  North  Carolina  State  Hoard 
of  Medical  Examiners;  from  1  '.hi l  to  1905  a 
member  of  the  State  Board  of  Health;  in  1885 
vice-president  of  the  Medical  Society  of  the  State 
of  North  Carolina,  lie  was  also  a  member  of 
the   Hoard   of  Directors  of   the  Central   Hospital 


THE   HOSPITAL  BULLETIN 


119 


for  tlic  Insane  at  Raleigh;  Since  I880,  when  be 
passed  the  examination  of  lieensenr  lie  lias  befell 
actively  engaged  in  the  practice  of  Ins  profession 
in  the  State  of  North  Carolina.  He  spent  his 
early  professional  career  in  Baltimore.  In  1892 
he  located  at  Rocky  Mount,  where  for  years  be  was 
division  surgeon  and  adjuster  of  damages  for  the 
Atlantic  Coast  Line  Railway.  He  enjoyed  a  large 
and  lucrative  practice,  was  greatly  loved  by  all 
with  whom  he  came  in  contact  and  stood  high  in 
the  esteem  of  his  fellows.  In  chronicling  the  death 
of  Dr.  Whitehead,  the  Old  Dominion  Journal  of 
Medicine  and  Surgery,  duly,  1909,  gave  voice  'to 
the  following  sentiments: 

"In  the  death  of  Doctor  William  Henry  White- 
head, of  Rocky  Mount.  X.  ('..  on  Thursday.  July 
1st,  1909,  the  medical  profession  of  the  South  has 
suffered  a  great  loss.  Unusually  strong  both  men- 
tally and  physically,  he  was  acknowledged  a  leader 
among  men.  A  useful  citizen,  he  was  ever  ready 
to  give  his  aid  where  worth  was  recognized,  and 
many  a  successful  man  owes  his  position  to  the 
helping  hand  extended  to  him  while  struggling 
for  an  education.  Whole-souled,  of  a  bright  and 
sunny  disposition,  he  carried  cheer  into  many  a 
home  darkened  by  the  shadow  «>f  suffering.  Dis- 
tinguished among  his  confreres  of  the  South,  he 
was  a  wise,  conservative  and  skillful  physician. 

"Doctor  Whitehead  was  horn  in  Edgecomb  coun- 
ty. North  Carolina,  in  1850.  His  parents  belong- 
ing to  the  oldest  and  best  families  of  that  com- 
munity, gentle  breeding  was  his  by  inheritance, 
and  lie  was  taught  early  that  high  standard  of 
morals  and  rectitude  to  which  he  so  rigidly  adhered 
dining  his  entire  life.  An  intense  lover  of  na- 
ture, he  was  as  a  boy  able  to  study  and  enjoy  it  to 
the  utmost  in  the  woods  and  by  the  gently  flowing 
streams  of  his  eastern  home.  Actively  engaged  in 
the  cultivation  of  his  father's  farm,  he  gained  a 
knowledge  and  experience  in  agricultural  life  that 
served  many  useful  purposes  in  his  after  life.  Here 
he  learned  to  appreciate  the  dignity  and  nobility 
of  human  labor,  and  also  the  proper  respect  and 
sympathy  for  the  laboring  man.  The  care  of  ani- 
mals intensified  the  spirit  of  innate  kindliness  and 
pity,  not  only  for  the  helpless  dumb  beast,  hut  in 
after  years  for  his  fellow  man.  Very  much  id'  his 
success  in  life  can  he  attributed  to  the  lessons  in 

ec my  and  industry  learned  during  these  early 

days  on  the  farm. 

"At  the  age  of  nineteen  he  commenced  the  study 
of  medicine,  and  graduated  from  the  medical  de- 
partment of  the   University  of  Maryland,   in  the 


elass  of    1870.     He   practiced   in   Battleboro  and 

gained  an  enviable  reputation  as  a  practitioner  and 
surgeon.  In  1891  he  accepted  the  position  of  chief 
snrg i  to  the  Atlantic  Coast  Line  Railroad  Hos- 
pital in  Rocky  Mount,  where  he  resided  up  to  his 
death.  He  was  local  surgeon  to  the  Southern 
Railway,  and  consulting  surgeon  to  the  I'ittman 
Sanitarium  in  Tarhoro,  North  Carolina.  His  death 
occurred  at  Raleigh,  where  he  had  been  under 
treatment  for  some  time. 

"We  of  Virginia  envy  our  sister  State  in  thus 
pioducing  so  splendid  a  type  of  the  "True  Physi- 
cian," and  share  with  her  the  sorrow  of  his  loss." 


.John  Woolf  Burton,  M.  D.,  University  of  Mary- 
land, Baltimore,  1865;  Washington  University, 
Baltimore,  1872;  for  many  years  a  member  of  the 

Medical  Society  of  the  State  of  North  Carolina; 
committed  suicide  at  his  home  in  High  Point, 
dune  30,  by  hanging  himself  in  his  stable,  while 
mentally  irresponsible  from  ill  health  and  despond- 
riicv.  aged  65. 


Richard  Benbuiy  Creecy  Lamb.  M.  I.).,  Uni- 
versity of  Maryland,  Baltimore,  1904;  of  Yslita, 
Texas;  died  in  Providence  Hospital,  El  Paso, 
Texas,  dune  22,  from  typhoid  fever,  aged  26. 


MARRIAGES. 

Doctor  .1.  P.  Young,  a  prominent  physician  of 
Richburg,  S.  ('.,  class  of  1894,  was  married  to 
Miss  Constance  Whitherspoon,  of  Lancaster,  S.  C, 
dune  23,  1909.  The  wedding  took  place  at  the 
home  of  the  bride's  brother,  Mr.  Marion  Wither- 
spoon,  in  Lancaster.  Soon  after  the  ceremony  the 
bride  and  groom  left  for  an  extended  bridal  tour 
in  the  North.  Upon  their  return  they  will  make 
their  future  home  in  Richburg. 


Doctor  John  W.  MacConnell.  class  of  1907,  of 
Davidson,  X.  C,  formerly  resident  physician  in 
the  Presbyterian  Eye.  Ear,  Nose  and  Throat  Hos- 
pital, of  Baltimroe,  was  married  Wednesday,  July 
28,  1909,  to  iliss  Agnes  H.  Doyle,  daughter  of 
Mr.  and  Mrs.  A.  Courtney  Doyle,  by  Reverend  D. 
D.  Douglas,  pastor  id'  Maryland  Avenue  Presby- 
terian Church,  at  the  residence  of  the  bride's  par- 
ents, Chestnut  avenue  and  Eleventh  street.  Wal- 
brook,  Baltimore.  Md.  After  the  ceremony  Dr. 
and  Mrs.  MacConnell  left  for  a  trip  North.  They 
will  make  their  home  at  Davidson,  X.  ('. 


i 

wntthfu* 

mMvrw 

(Inflammation 's 

Antidote) 

I       £ 

applied  from  ear  to  ear  as  hot  as  can  be 
born  comfortably  by  the  patient,  depletes 
the  enlarged  lymph  glands,  guards  against 
the  passage  of  toxines  into  the  circulation 
and   reduces   the    liability  of    Mastoiditis, 
Middle  Ear  and  Laryngeal  complications  in 
Tonsilitis,  Scarlatina,  and  other  diseases  of 

similar  nature. 

The  dressing  of  Antiphlogistine  must 
be  at  least  an  eight  of  an  inch  thick,  cover- 
ed with  a  plentiful  amount   of   absorbent 
cotton  and  held  snugly  in  place  by  a  band- 

f^^J         '"''  £&''    1^' 

age. 

^m***^  •*. 

THE  DENVER  CHEMICAL 

^•■■J 

^SS0^^ 

MFG.  CO.                   New  York 

ERTAIN  23  it  is  that  a  single  acting  cause  can  bring 
about  any  one  of  the  several  anomalies  of  menstrua- 
tion, just  so  certain  is  it  that  a  single  remedial  agent 
—  if  properly  administered  —  can  effect  the  relief  of 
any  one  of  those  anomalies. 

<J  The  singular  efficacy  of  Ergoapiol  (Smith)  in  the 
various  menstrual  irregularities  is  manifestly  due  to  its  prompt 
and  direct  analgesic,  antispasmodic  and  tonic  action  upon  the 
entire  female  reproductive  system. 

<J  Ergoapiol  (Smith)  is  of  special,  indeed  extraordinary,  value  in 
such  menstrual  irregularities  as  amenorrhea,  dysmenorrhea, 
menorrhagia  and  metrorrhagia. 

<§  The  creators  of  the  preparation,  the  Martin  H.  Smith 
Company,  of  New  York,  will  send  samples  and  exhaustive 
literature,  post  paid,  to  any  member  of  the  medical  profession. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 

PRICE     ^l.OO     PER     YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter. 


Vol.  V 


BALTIMORE,  MD.,  SEPTEMBER  15,  1909. 


No.  7 


THE  PROFESSOBS  OF  SURGERY  IN  THE 
UNIVERSITY  OF  MARYLAND. 


]'>v  Randolph  Winslow,  M.  D. 


No.  1. 


)iix  Bealb  Davidge,  A.  M.,  M.  D. 


In  the  first  hundred  years  of  the  existence  of 
the  University  of  Maryland  there  have  been  seven 
professors  of  surgery — lohn  B.  Davidge,  William 
Gibson,  Granville  Sharp  Pattison,  Nathan  1!. 
Smith,  Christopher  Johnston,  Louis  McLane 
Tiffany   and   Randolph   Winslow. 

1  desire  to  present  short  sketches  of  my  pre- 
decessors in  the  surgical  chair  in  order  that  our 
si u dents  and  graduates  may  have  some  knowledge 
of  those  who  have  filled  this  chair,  from  the  be- 
ginning of  the  school  to  the  present  time.  These 
sketches  will  contain  nothing  original  by  me,  but 
are  merely  condensed  histories  taken  from  "The 
History  of  the  University  of  Maryland/'  written 
by  Prof.  E.  F.  Cordell.  These  men  have  all  been* 
distinguished  in  their  day  and  generation  and 
have  rendered  important  and  valuable  services  in 
the  cause  of  humanity  and  of  science.  The  first 
of  these  is 

John  B.  Davidge. 

The  charter  for  the  founding  of  the  College  of 
Medicine  of  Maryland  was  granted  by  the  Legis- 
lature on  December  18,  1807.  In  the  16th  sec- 
tion of  this  charter  it  is  enacted  that  .John  B. 
Davidge,  M.  D.,  and  James  Cocke,  M.  D.,  shall 
be  joint  professors  of  anatomy,  surgery  and  physi- 
ology. In  the  division  of  this  work  Dr.  Davidge 
delivered  the  lectures  on  surgery  until  1812,  when 
Dr.  William  Gibson  was  elected  professor  of 
surgery,  and  held  the  chair  until  1819.  Dr. 
Davidge  during  that  period  conducted  the  courses 
of  instruction  in  anatomy.  From  1819  to  1821 
Dr.  Davidge  discharged  the  duties  of  both  the 
surgical  and  anatomical  chairs,  when  Granville 
Sliarpe  Pattison  was  elected  to  the  chair  of  sur- 
gery. In  1826  he  again  took  up  the  duties  of 
the  chair  of  surgery,  upon  the  resignation  of  Pro- 


fessor Pattison.  He  relinquished  the  chair  in 
L827,  when  Dr.  Nathan  R.  Smith  was  elected 
professor  of  surgery. 

Dr.   John  B.    Davidge   was   horn   in   Annapolis 
in    1768.     His    father   died    whilst    he   was    still 

young,  and  he  became  reduced  in  circumstances. 
but  with  some  assistance  he  was  enabled  to  enter 
St.  John's  College  and  obtained  therefrom  the 
degree  of  A.  M.  in  1789.  He  began  the  study  of 
medicine  with  the  Drs.  Murray,  of  Annapolis, 
and  later  entered  the  University  of  Edinburgh, 
but  took  his  degree  of  Doctor  of  Medicine  at  Glas- 
gow University,  Scotland,  on  the  22nd  of  April, 
1793.  lie  married  a  Scotch  lady  and  practiced 
a  short  time  in  Birmingham,  England,  hut  soon 
returned  to  Maryland,  and  settled  in  Baltimore 
in  August  of  1796.  A  severe  epidemic  of  yellow 
fever  prevailed  in  the  city  in  1797,  and  Dr. 
Davidge  formed  very  definite  opinions  in  regard 
to  the  origin  of  this  disease,  and  came  near  being 
the  discoverer  of  the  causation  of  the  disease  by 
means  of  the  bite  of  infected  mosquitoes,  which 
discovery  has  since  made  the  names  of  Walter 
Reed  and  James  Carroll  and  Jesse  Lazear  famous. 
Dr.  Davidge  published  his  views  on  yellow  fever 
in  1798,  in  a  volume  which  attracted  considerable 
notice.  In  1802  he  began  to  give  private  courses 
of  instruction  to  medical  students,  which  were 
continued  until  1807,  when,  being  associated  with 
Drs.  Cooke  and  Shaw,  his  private  school  became 
the  College  of  Medicine  of  Maryland,  which  later 
became  the  University  of  Maryland.  Dr.  Davidge 
thus  became  the  founder  of  the  University  of 
Maryland  and  was  known  as  the  Father  of  the 
University.  He  was  twice  married,  the  first  time 
as  stated  to  a  Scotch  lady.  Miss  William  Stuart, 
and  after  her  death,  to  Mrs.  Rebecca  Troup  Polk, 
of  Harford  county,  Maryland,  who  survived  him 
with  four  children,  a  son  by  his  first  wife,  and 
three  daughters  by  his  second.  Professor  Davidge 
is  said  to  have  been  a  short  man,  with  blue  eyes 
and  a  ruddy  complexion  aud  homely  features.  He 
was  neat  in  his  dress  and  dignified  in  his  man- 
ner,  and    acquired   a   large   practice   in   the    <  'ii\ 


122 


THE  HOSPITAL  BULLETIN 


of  Baltimore.  He  was  a  person  of  great  influence 
in  the  medical  profession  of  the  day.  and  though 
of  somewhat  irritable  disposition,  he  was  much 
regarded  by  his  acquaintances,  and  held  in  high 
esteem  by  his  students.  He  was  an  excellent  lec- 
turer, and  a  diligent  student,  hut  was  an  obscure 
writer,  and  expressed  himself  in  pompous  and 
confusing  language.  Surgery  was  at  this  time 
more  or  less  in  its  infancy,  and  the  surgeons  were 
also  practitioners  of  medicine.  He  performed, 
however,  several  important  operations,  such  as 
total  extirpation  of  the  Parotid  Gland,  ligation 
of  the  Gluteal  Artery  for  aneurism,  and  ligation 
of  the  Carotid  Artery  for  fungus  of  the  Antrum. 
He  also  invented  a  new  method  of  amputation, 
which  he  called  the  American.  Hi'  wrote  a  trea- 
tise on  yellow  fever  in  1798,  a  treatise  on  am- 
putation in  1818,  and  edited  Bancroft  on  fevers 
in  1831,  and  was  besides  a  frequent  contributor 
to  the  medical  and  scientific  journals  of  his  day. 
He  died  at  his  residence  on  Lexington  street,  on 
the  23rd  of  August,  1S29,  the  cause  of  death 
being  a  malignant  growth  of  the  face,  originating 
in  the  Antrum.  The  disease  was  first  noticed  in 
June,  1829,  and  grew  rapidly  and  was  accom- 
panied with  great  suffering.  At  this  late  period 
in  the  history  of  the  University  a  memorial  has 
been  established  to  him  by  renaming  the  recently 
acquired  Calvary  Church,  which  is  now  used  as 
a  library  and  Y.  M.  C.  A.  building,  Davidge  Hall. 


LEUCORRHOEA. 


By  Hugh  W.  Brent,  M.  D., 


Instructor  in  Gynecology,  University  of  Maryland. 

The  importance  of  leucorrhoea  as  a  symptom 
(if  pelvic  diseases  finds  no  place  in  the  mind  of 
the  average  woman — to  her  "whites  are  whites," 
and  that  settles  the  question  unless  the  co-existent 
disease  be  of  such  character  as  to  attract  her 
attention  through  the  medium  of  pain,  the  dis- 
comfort  of  "profuseness"  or  the  sometime  result- 
excoriation  of  the  vulva  and  adjacent  skin  sur- 
faces. 

Woman  unenlightened,  regards  the  symptom  as 
a  disease  and  through  ignorance  fails  to  properly 
interpret  the  subtle  warning  in  an  intelligent  way. 
And  why  should  she  not  he  ignorant? — as  ignor- 
ani   as  we  may  he  of  astrology  or   Hindu  magic. 


Vnii  see  it  doesn't  happen  to  he  in  her  line  to 
know  Hi,,  "why"  ami  "wherefore."  She  looks  to 
the  physician  to  ferret  out  the  seat  of  evil  and 
"properly  interpret" — you  sec  it  happens  to  be 
our  business  tu  understand  these  things,  to  look 
beyond  "whiles  are  whites."  To  blithely  prescribe 
hot  douches  for  "that  vaginal  discharge"  may  be 
a  procedure  beyond  reproach  or  it  may  be  dan- 
gerous, irrational  and  useless,  a  trio  certainly  de- 
sen  ing  consideration  if  one  is  to  practice  Medi- 
cine nut  medicine. 

The  causes  of  leucorrhoea  are  myriad  and  un- 
til we  have  solved  its  raison  d'etre  with  at  least 
reasonable  certainty  we  are  not  justified  in  at- 
tempting its  correction.  True  the  cause  is  often 
difficult  of  discovery,  but  in  the  majority  of  cases 
painstaking  examination  will  reveal  the  under- 
lying pathologic  process,  and  we  will  be  enabled 
to  establish  a  rational  line  of  treatment.  It  may 
lie  well  to  first  briefly  consider  the  normal  physi- 
ologic secretions  of  the  genitalia  derived  from  the 
glandular  systems  of  the  vulva,  Bartholin's  glands, 
Skene's  glands,  the  cervix  and  corpus  uteri.  The 
vagina  closely  approaches  the  skin  in  structure 
and  is  practically  non-secretory  though  a  few  iso- 
lated glands  are  occasionally  found  in  this  local- 
ity. Its  surface  is  bathed  in  the  uterine  and 
cervical  secretions,  thickened  with  desquamated 
vaginal  cells  and  rendered  acid  through  the  nor- 
mal presence  of  non-pathogenic  acid  producing 
organisms,  notably  the  Bacillus  Vaginalis  of 
Doederlein.  In  health  is  varies  considerably  in 
amount  and  is  much  increased  during  pregnancy 
when  the  cervical  glands  are  especially  active  and 
the  cycle  of  cellular  life  in  the  vaginal  mucosa, 
hastened  through  the  impetus  of  increased  nutri- 
tion, increases  the  amount  of  cellular  debris.  Espe- 
cially (lining  the  latter  part  of  pregnancy  one 
may  expect  to  encounter  a  rather  profuse  vaginal 
discharge,  which  is  in  no  way  pathologic. 

The  vulva  is  generously  supplied  with  sweat 
and  sebaceous  glands,  their  activity  varying  with 
(he  individual  and  the  seasons.  The  normal  se- 
cretions of  the  vulva  may,  however,  in  uncleanly 
women  become  through  accumulation  and  decom- 
position a  source  of  irritation.  Bartholin's  vulvo- 
vaginal glands  pour  out  on  cither  side  of  vaginal 
outlet,  through  ducts  opening  in  front  of  the 
hymen  a  thin,  transparent  mucoid  secretion  de 
signed  as  a  lubricant  during  coition.  When  not 
influenced  psychically  they  are  almost  quiescent — 
and    very    naturally    so.      Their    function    has    to 


THE  HOSPITAL  BULLETIN 


123 


do  with  sexual  activity  and  it  is  only  under  the 
influence  of  sexual  excitement  that  they  become 
functionally  active.  Secretion  at  this  time  may 
be  extremely  profuse,  but  should  be  ever  borne 
in  mind  as  entirely  normal,  the  amount  varying 
with  the  intensity  of  the  individual's  desire. 

Skene's  glands,  situated  on  either  side  of  the 
urethra,  empty  their  secretion  on  the  inner  aspect 
of  the  labial  urethrae,  their  function  is  the  lubri- 
cation of  the  urethral  orifice  and  their  small  size 
renders  them  insignificant  (even  when  infected) 
as  a  source  of  discharge. 

The  secretions  of  the  clitoris  are  so  slight  in 
health  as  to  escape  notice,  an  adherent  prepuce 
or  uncleanliness  may  however  give  rise  to  more 
(>]•   less  trouble   of  an   irritative  character. 

We  come  now  to  the  two  most  important,  glandu- 
lar systems  associated  with  the  production  of  leu- 
corrhoea — those  of  the  corpus  uteri  and  cervix. 
Their  secretions  differ  very  essentially  and  it  is 
often  p  issible  to  determine  the  source  of  discharge 
by   the   physical   characteristics   of  the   secretions. 

The  cervical  glands  tortuous  and  deeply  situated 
evolve  a  clear  viscid  alkaline  mucous — the  uterine 
glands  much  less  complicated  in  structure,  secrete 
a  thin,  setoits  alkaline  fluid,  destined  to  moisten 
the  uterine  mucosa,  but  having  as  one  of  its 
principal  functions  the  prevention  of  clot  forma- 
tion in  the  menstrual  blood. 

Before  considering  the  pathology  of  leucorrhoea 
1  wish  to  mention  the  normal  premenstrual  in- 
crease in  glandular  activity,  under  the  stimula- 
tion of  premenstrual  pelvic  congestion.  This 
period  of  hypersecretion,  if  I  may  term  it  such, 
is  directly  responsible  for  the  widespread  belief 
among  the  laity  that  menstrual  blood  is  produc- 
tive of  gonorrhoea]  infection,  i.  e.,  the  menstrual 
blood  of  a  healthy  woman.  This  of  course  is  ab- 
surd, hut  it  is  well  to  hear  in  mind  that  women 
are  especially  likely  to  transfer  the  disease  at  this 
time,  for  the  following  reason:  Hypersecretion 
tends  to  "bring  out"  organisms  lying  quiescent 
in  the  depths  of  a  gland  and  the  woman  may 
(bus  become  actively  infectious,  though  exhibiting 
a  comparatively  slight  tendency  toward  transfer- 

ei f    the    disease    during    the    inter-menstrual 

period. 

The  Pathology,  of  Leucorriioea. 

Genera]  Svstemic  Disease. 

Pelvic  Congestion. 

Uterine  Malposition. 

Foreign  Bodies. 


Cancer  of  the  Cervix   ami  Corpus  Uteri. 
Genital    Tuberculosis. 

Puerperal     Infections    and     the    Traumata     of 
Labor. 
( fonorrhoea. 

The  influence  id'  extra-genital  diseases  in  the 
causation  of  leucorrhoea  is  indefinite  and  infre- 
quent— the  popular  assumption  that  •'whites"  are 
the  result  of  "weakness"  (whatever  that  may  be) 
is  merely  a  confession  of  ignorance.  With  the 
exception  of  the  possible  influence  of  chronic  con- 
stipation and  such  lesions  of  the  heart,  lungs, 
liver  or  kidneys  that  may  cause  stasis  of  the  pel- 
vie  blood  supply  through  circulatory  obstruction, 
we  may  practically  disregard  extra-pelvic  affec- 
tions as  etiologic  factors. 

Pelvic  congestion  from  whatever  cause  is  a  pro- 
lific source  of  "vaginal  discharge."  As  the  gross 
lesions  of  the  pelvis  causing  congestion  will  be 
considered  later  it  may  be  well  to  discuss  here  an 
element  of  psychic  origin  that  plays  no  small  part 
in  this  relation.  Sexual  excitement  without  grati- 
fication is  entirely  unnatural  from  the  view  point 
of  the  animal  organism.  The  natural  law  of  sex- 
ual relation  demands  that  libido-sexualis,  with  its 
attendant  pelvic  congestion  and  nervous  excita- 
tion be  followed  by  completion  of  the  sexio-erotic 
cycle  through  natural  coitus  with  orgasm.  If 
for  any  reason,  physical,  social,  moral,  or  mar- 
ital, there  is  continual  violation  of  this  basic  prin- 
ciple we'  may  expect  to  find  in  the  woman  the 
usual  concomitants  of  chronic  pelvic  and  ovarian 
congestion — pain,  reflex  nervous  phenomena  and 
leucorrhoea,  a  leuchorrhoea  entirely  unrelievable 
by  local  applications  "to  the  womb"  or  the  famous 
''hot  douche." 

Uterine  malposition,  especially  retro-displace- 
ment and  prolapsus,  are  often  accompanied  by 
venous  stasis  in  the  uterus,  and  its  almost  in- 
e\  itable  sequence — endometrial  hypersecretion. 

Foreign  bodies  whether  pessaries  or  the  instru- 
ments of  masturbation  may  cause  vaginitis  or  ul- 
ceration of  such  degree  as  to  give  rise  to  profuse 
"vaginal   discharge." 

Genital  tuberculosis  usually  affects  not  only  the 
uterus  but  the  adnexa  and  pelvic  peritoneum  as 
well,  unless  the  bacillus  can  lie  demonstrated  in 
the  discharge  or  the  characteristic  lesions  recog- 
nized microscopically  in  uterine  scrapings,  a  posi- 
tive diagnosis  can  rarely  bo  made.  Of  course 
where  salpingitis  is  coexistent  an  abdominal  sec- 
tion reveals  the  true  state  of  affairs. 


124 


'HE   HOSPITAL  BULLETIN 


I  n  malignant  disease  of  the  uterus  the  firstdis- 
charge  noted  is  clear  and  watery,  the  producl  of 
congestion  and  the  new  growth.  This  watery  dis- 
charge associated  with  monorrhagia  or  metrorrha- 
gia occurring  ahoul  the  menapause  should  at  mice 
excite  suspicion  of  cancer  and  is  an  indication 
for  immediate  and  searching  investigation.  We 
must  ever  bear  in  mind  in  this  connection  that 
cancer,  though  commonly  considered  as  occurring 
rather  late  in  life,  is  sometimes  met  with  in  young 
women.  As  the  disease  progresses  and  necrosis 
with  ulceration  occurs  the  discharge  becomes  thick, 
corrosive  and  fetid,  parametria!  invasion  has 
taken  place  and  the  golden  opportunity  for  radi- 
cal extirpation  of  the  growth  is  a  thing  of  the 
past.  In  the  pathologic  causation  id'  leucorrhoea 
we  may  consider  the  traumata  and  infections  of 
labor  ami  the  puerperium  as  playing  a  role  second- 
ary only  to  gonorrhoea]  invasion  of  the  genital 
tract. 

Cervical  laceration  with  infection  is  a  common 
cause  of  "discharge"  and  may  he  the  single  lesion 
in  a  profuse  leucorrhoea.  Even  iir  those  eases  in 
which  no  discoverable  laceration  exists,  minor 
tears  in  the  mucosa  and  musculature  of  the  cer- 
vix within  the  canal,  may  become  infected  during 
the  puerperium,  tin'  only  clinical  evidence  of  their 
existence  being  the  characteristic  mucopurulent 
discharge  and  associated  erosion  of  the  porti  vag- 
inalis. Inflammation  of  the  endometrium  is  not 
as  common  as  one  might  think  and  when  it  does 
occur  is  not  likely  to  he  of  long  duration.  We 
do  indeed  often  encounter  a  discharge  in  child- 
hearing  women,  the  product  of  the  endometrium, 
hut  this  is  in  most  cases  a  hypersecretion  brought 
about  by  congestion  dependent  upon  subinvolution 
or  displacement,  or  both. 

Acute  puerperal  infections  may  or  may  not  be 
accompanied  by  leucorrhoea.  though  as  the  dis- 
ease advances  it  always  makes  its  appearance  and 
may  be  very  profuse.  The  etiology  is  found  in 
endocervicitis,  endometritis,  metritis,  salpingitis 
and  pelvic  peritonitis;  either  of  these  is  sufficient 
or  the  entire  group  may  be  coexistent. 

The  leucorrhoea  accompanying  a  puerperal 
salpingitis  differs  little  from  that  seen  in  tubal 
inflammation  of  gonorrhoea]  origin  with  the  ex- 
ception of  the  possible  demonstration  of  the 
gonococcus.  The  discharge  in  salpingitis  is  usu- 
ally directly  dependent  upon  the  chronic  pelvic 
congestion    associated    with    pelvic    inflammatory 


disease.     Of  course  in  some  cases  there  is  an  as- 
sociated  endometritis. 

That  occasionally  drainage  does  occur  through 
the  uterine  end  of  the  tube  is  not  to  lie  denied, 
hut  it  is  very  rare.  Inflammatory  thickening  of 
the  mucosa  in  this  the  narrowest  portion  of  the 
canal,  effectually  prevents  the  extrusion  of  the 
products  of  inflammation  into  the  uterine  cavity. 

hi  hydrosalpinx  which  is  usually  of  inflam- 
matory origin  we  occasionally  encounter  the  so- 
called  •'Hydrops  Tubae  Profluens,"  in  which  the 
tube  periodically  empties  itself  by  way  of  the 
uterus.  The  condition  is  comparatively  rare  and 
is  probably  due  to  causes  other  than  pre-existent 
pyosalpingitis. 

The  point  of  importance  in  tubal  disease  is, 
that  it  is  folly  to  tieat  minor  conditions  in  the 
cervix  and  uterus  without  bimanual  pelvic  exam- 
ination. Jf  one  lie  guilty  of  this  indiscretion  be 
may  expect  often  to  miss  the  true  source  of  the 
leucorrhoea — "higher  up." 

Gonorrhoea  is  by  far  the  most  important  etio- 
logie  factor  in  genital  discharge,  not  only  because 
of  its  frequency,  but  through  the  extremely  serious 
consequences  resulting  from  failure  to  recognize 
this  disease.  Gonorrhoea  in  the  female  is  diffi- 
cult to  combat  when  one  fully  realizes  its  power 
for  harm  and  is  thoroughly  competent  and  con- 
scientious in  its  treatment.  The  existence  of  such 
a  malady  is  sufficient  in  itself  to  demand  of  every 
physician  worthy  of  the  name  a  searching  in- 
vestigation when  he  is  called  upon  to  treat  "that 
little  discharge."  Infection  of  the  entire  genital 
mucosa  and  glandular  system  is  not  uncommon 
in  acute  gonorrhoea,  but  as  the  disease  becomes 
chronic  there  is  a  tendency  toward  localization  in 
cei  tain  areas,  noticeably  Bartholin's  glands  the 
cervical  and  corporeal  endometrium  and  the  fal- 
lopian tubes.  In  these  structures  it  may  remain 
semi-latent  for  years — a  source  of  discomfort  and 
leucorrhoea  to  the  woman  and  a  potent  factor  in 
the  dissemination  of  the  disease  through  pros- 
titution. Clinically,  the  discbarge  in  gonorrhoea 
is  characteristic,  viewed  by  the  experienced  eye. 
But  before  making  a  diagnosis  it  is  preferable 
to  demonstrate  the  gonococcus — the  best  "smears" 
being  obtainable  from  the  urethra  and  Bartholin's 
gland-. 

Leucorrhoea  is  a  vast  subject  and  the  author 
appreciates  the  woeful  deficiency  of  such  a  brief 
paper.  If.  however,  he  has  made  plain  that 
''vaginal  discharge"  is  always  due  to  some  specific 


THE  HOSPITAL  BULLETIN 


125 


lesion  usually  discoverable  through  painstaking 
examination  and  that  only  through  treatment  of 
the  cause  can  one  hope  to  be  successful  in  its 
cure — be  will  feel  that  the  time  consumed  in  the 
preparation  of  this  aiticle  has  been  well  em- 
ployed. 

3124   Mai  viand   Avenue. 


A  CASE  OP  FRACTURE  OF  THE  CLAVICLE 
WITH  PECULIAR  SYMPTOMS. 


By  Everette  Iskmax.  '09, 


Senior  Medical  Student. 

Fracture  of  the  clavicle  is  the  most  common  of 
all  fractures,  and  the  symptoms  are  usually 
characteristic  but  in  some  exceptional  eases,  the 
clavicle  may  be  fractured  without  presenting  the 
usual  symptoms.  A  ease  of  tins  character  came 
recently  under  our  observation. 

Case — (!.  K.,  white,  age  16  years,  a  sailor  by  oc- 
cupation, was  admitted  to  the  University  Hospital 
on  January  19,  1909.  Four  days  previously  whilst 
going  down  a  ladder  on  shipboard,  he  slipped  and 
fell  about  five  or  six  feet,  striking  his  head  first 
and  then  his  left  shoulder.  He  was  able  to  get  up 
but  found  that  his  left  shoulder  pained  him  a  little. 
This  was  about  8  o'clock  in  the  evening,  about  4 
o'clock  in  the  morning  lie  awoke  with  a  great  deal 
of  pain  in  the  shoulder  and  the  ship's  doctor  was 
called  and  examined  him,  and  pronounced  the  in- 
jury a  bruise.  The  arm  was  put  up  in  a  bandage 
which  gave  him  relief  from  pain.  Two  days  later 
the  bandage  was  removed  and  the  hoy  could  move 
his  arm  in  any  direction  without  pain,  and  could 
also  put  his  hand  on  his  head,  and  swing  his  aim 
backwards  and  forwards  without  discomfort.  Upton 
reaching  Annapolis,  he  was  examined  by  one  of 
the  surgeons  of  the  Naval  Academy,  who  also  did 
not  think  that  there  was  a  fracture,  hut  recom- 
mended sending  him  to  Baltimore  to  a  hospital,  as 
the  boy  was  unable  to  work.  When  he  was  ad- 
mitted to  the  University  Hospital,  a  lump  was 
found  in  the  middle  of  the  clavicle  but  the  boy 
could  move  the  arm  in  any  direction  without  pain, 
he  could  also  put  the  hand  of  the  injured  side  upon 
the  top  of  his  head  without  the  least  difficulty, 
hence  it  was  thought  by  the  physician  who  ad- 
mitted him  that  the  injury  was  a  bruise  and  not 
a  fracture.  The  next  day  when  Professor  Winslow 
made  his  rounds  of  the  wards,  the  case  was  called 


to  his  attention,  and  he  found,  as  has  been  stated,  a 
lump  over  the  middle  of  the  clavicle,  which  was  not 
tender  upon  pressure  but  was  discolored  from  con- 
tusion. Upon  manipulating  the  parts  it  was  pos- 
sible to  get  distinct  motion  and  crepitus  at  this 
point,  and  it  was  evident  that  a  fracture  was 
present  at  the  middle  third  of  the  collar  hone.  The 
hoy  was  perfectly  able  to  place  his  hand  on  the  top 
of  his  head  without  inconvenience,  and  could 
readily  move  his  arm  in  any  direction.  He  was 
placed  upon  the  table  with  a  pillow  between  his 
shoulders  causing  the  shoulders  to  he  thrown  back- 
wards and  the  left  arm  was  abducted  and  rotated 
outward.  Whilst  in  this  position  a  plaster  cast 
was  applied  to  his  chest  and  arm,  fixing  the  arm 
in  this  position,  with  firm  pressure  upon  the  point 
of  fracture.  The  east  was  comfortable  to  the 
patient  ami  was  not  removed  until  February  25, 
when  firm  union  was  found  to  have  taken  place, 
witli  hut  slight  deformity.  One  of  the  charac- 
teristic features  of  a  broken  collar  hone  is  the 
absolute  inability  of  the  patient  to  execute  the 
ordinary  movements  of  the  arm  or  to  put  the  hand 
upon  the  top  of  the  head.  Deformity  is  usually 
present  at  the  seat  of  fracture,  as  was  the  ease  in 
this  instance;  usually  there  is  no  displacement  or 
deformity  in  a  case  of  fracture  of  the  clavicle,  when 
the  break  is  situated  about  one  inch  from  the  outer 
extremity  <d'  the  bone.  Running  from  the  coracoid 
process  to  the  under  surface  of  the  clavicle  are  two 
ligaments  known  as  the  conoid  and  the  trapezoid 
ligaments.  When  a  fracture  of  the  collar  hone  oc- 
curs about  one  inch  from  its  outer  extremity,  the 
line  id'  fracture  lies  between  the  conoid  and  trape- 
zoid ligaments  and  there  is  no  displacement  of  the 
fragments.  In  all  other  forms  of  fracture  of 
this  bone  there  is  both  displacement  and  deformity. 
Sometimes  with  this  form  of  fracture  the  person 
may  he  able  to  use  the  arm  though  usually  with 
difficulty. 

Another  ease  occurring  in  the  practice  of  Pro- 
fessor Winslow,  illustrating  these  points,  was  that 
of  a  colored  woman,  who  having  an  altercation 
with  her  husband,  was  thrown  by  him  against  the 
door,  injuring  her  shoulder.  When  seen  the 
woman  was  ironing  clothes,  though  with  pain,  and 
she  could  also  place  her  hand  on  her  head.  There 
was  absolutely  no  displacement  of  the  bones  and 
no  deformity,  but  when  the  shoulder  was  carefully 
examined  distinct  crepitus  could  he  felt  at  the 
outer  extremity  of  the  clavicle,  showing  that  a 
fracture  had  taken  place.     I  have  reported  these 


126 


THE   HOSPITAL,  BULLETIN 


cases  as  they  are  unusual,  and  serve  to  show  that 
variations  occur,  and  hence  the  necessity  of  making 
careful  examinations  in  all  cases  of  fracture  aboul 
the  neck  and  shoulder  as  well  as  in  all  other 
regions  of  the  body. 


ABSTRACTS. 


IS   PUBIOTOMY  A   JUSTIFIABLE 
OPERATION? 

J.  Whitridge  Williams,  class  of  1888,  Johns 
Hopkins  University.  (American  Journal  of 
Obstetrics.) 

"Thus,  assuming  that  the  figures  given  above 
are  approximately  correct  and  thai  two  series  of 
l3000  cases  of  moderately  contracted  pelves  were 
treated  by  pubiotomy  and  the  induction  of  labor, 
respectively,  il  would  appear  that  the  former  opera- 
tion would  be  required  in  fifty  and  the  latter  in 
250  women;  and  that  if  the  maternal  mortality 
were,  respectively,  2  and  1-3  per  cent,  the  num- 
bers of  deaths  would  be  identical  in  both  series. 
On  the  other  hand,  admitting  that  the  fetal  mor- 
tality were  10  and  25  per  cent.,  respectively,  five 
children  would  be  lost  in  the  former  and  sixty-two 
in  the  latter  series.  Or.  to  put  the  matter  more 
forcibly,  a  greater  number  of  children  would  have 
been  saved  had  craniotomy  been  perforemd  in  all 
cases  in  which  pubiotomy  was  indicated." 

"Naturally,  it  might  be  suggested  by  the  advo- 
cates of  the  induction  of  premature  labor  thai  such 
calculations  are  not  convincing.  That  they  are 
not  purely  speculative,  however,  is  demonstrated 
by  the  figures  recently  adduced  by  Burger,  which 
are  based  upon  analysis  of  1.0.000  labors  occurring 
in  Schauta's  clinic  in  Vienna.  In  this  series  there 
were  -I. ".MO  contracted  pelves  with  a  fetal  mortality 
of  only  22  per  cent,  in  the  cases  in  which  spontane- 
ous labor  occurred  ;  whereas  it  rose  to  4.3  per  cent, 
in  cases  treated  expectantly,  including  all  deaths 
following  craniotomy,  pubiotomy,  and  Cesarean 
section.  Results  which  cannot  be  approximated  by 
the  most  enthusiastic  advocate  of  the  induction  of 
labor." 

"Having  shown  that  pubiotomy  is  superior  to 
the  induction  of  labor  and  symphyseotomy,  it  re- 
mains to  consider  to  what  extent  it  enters  into 
competition  with  Cesarian  section.  In  the  first 
place,  il  must  be  stated  that  the  former  operation 
is  not  indicated  when  the  conjugata  vera  measures 
less  than  ">  cm.  Consequently  there  can  be  no  com- 
petition in  the  pelves  above  thai  limit;  namely, 
in  the  so-called  "border-line"  cases,  in  which  it  is 


generally  impossible  to  predict  the  outcome  of 
labor  in  any  given  case.  Moreover,  it  must  be  ad- 
mitted that  if  the  decision  were  based  entirely 
upon  the  general  mortality  of  the  two  operations, 
it  would  have  to  be  given  in  favor  of  pubiotomy, 
as  an  analysis  of  the  reports  of  the  best  operators 
shows  that  the  average  mortality  in  Cesarean  sec- 
tion is  in  the  neighborhood  of  5  per  cent." 

"The  researches  of  Reynolds,  however,  indicate 
that  this  figure  does  not  altogether  represent  the 
true  slate  of  affairs,  but  that,  admitting  the  com- 
petence of  the  operator  and  the  excellence  of  his 
technic,  the  results  will  vary  greatly  according  to 
the  period  of  labor  at  which  the  operation  is  per- 
formed. Thus,  in  an  analysis  of  289  eases,  he 
found  that  the  mortality  was  1.3,  3.8  or  12  per 
cent.,  respectively,  according  as  the  operation  was 
performed  dining  the  last  days  of  pregnancy,  or 
early  or  late  in  labor.  As  his  results  are  in  ac- 
cordance with  my  own  experience,  I  feel  justified 
in  holding  that  the  results  of  Cesarean  section  per- 
formed just  before  or  at  the  very  onset  of  labor 
are  superior  to  those  of  pubiotomy.  both  as  regards 
the  actual  mortality  and  ease  of  convalescence  of 
the  mother,  not  to  mention  the  fact  that  all  of 
the  children  are  saved,  instead  of  only  95  per 
cent.,  as  in  pubiotomy.  On  the  other  hand  Cesar- 
ean section  performed  early  in  labor  has  a  some- 
what greater  mortality  than  pubiotomy;  while  if 
not  resorted  to  until  the  second  stage  is  well  ad- 
vanced there  can  be  no  comparison  between  the 
two  operations,  as  the  former  has  a  mortality  of  Id 
or  1".'  per  cent,  and  the  latter  of  only  2  per  cent.  ' 

"Accordingly,  if  it  were  possible  to  predict  in  a 
given  case  that  engagement  would  not  occur,  the 
best  interests  of  both  the  mother  and  child  would 
be  served  by  performing  Cesarean  section  at  an 
appointed  time  a  few  days  before  the  expected  date 
of  confinement ;  as  by  so  doing  the  child  would  cer- 
tainly be  saved,  with  a  minimal  risk  and  an  al- 
most ideal  convalescence  for  the  mother.  Un- 
fortunately, in  the  class  of  pelves  under  considera- 
tion, such  a  prediction  is  never  possible  in  women 
pregnant  for  the  first  time  and  only  exceptionally 
in  multiparae.  Therefore,  in  primiparae,  Cesar- 
ean section  would  not  be  indicated  at  the  time  of 
election,  unless  one  were  willing  to  assume  the 
responsibility  of  operating  unnecessarily  upon  a 
considerable  number  of  women  when  one  knew  by 
experience  that  a  large  proportion  of  them  would 
be  delivered  spontaneously  if  subjected  to  the  lest 
of  labor.  For  this  reason,  early  elective  Cesarean 
section   would  be  justified  only  in  multiparae  in 


THE  HOSPITAL  BULLETIN 


127 


whom  the  history  of  previous  labors  had  clearly 
indicated  that  nature  was  habitually  unable  to 
overcome  the  disproportion  between  the  size  of  the 
head  and  the  pelvis." 

"On  the  other  hand,  if  Cesarean  section  is  not 
done  at  the  very  unset  of  labor,  1  consider  thai 
the  besi  interests  of  the  patient  will  be  served  if 
she  be  treated  expectantly,  allowed  to  go  into  the 
second  stage  of  labor,  and  then  subjected  to  pubi- 
otomy,  it'  engagement  does  not  occur  after  several 
hours  id'  strong  pains,  or  in  the  presence  of  cer- 
tain conditions  which  indicate  the  necessity  for 
prompt  delivery." 

"To  my  mind,  the  great  advantage  of  pubiotomy 
in  tin'  treatment  of  border-line  cases  of  pelvic  con- 
traction consists  in  the  fact  that  it  affords  the  pos- 
sibility of  subjecting  the  patient  to  throes  of  labor 
in  suitable  cases  and  then  of  interfering  for  the 
sake  of  the  child  without  subjecting  the  mother  to 
too  great  danger.  In  other  words,  it  enters  into 
competition  with  high  forceps,  prophylactic  ver- 
sion and  craniotomy  rather  than  with  Cesarean 
-eei  ion." 

"I  desire  to  emphasize  the  fact  that  if  good  re- 
sults are  too  be  obtained,  pubiotomy  should  be  re- 
garded as  a  primary  operation,  and  should  not  be 
resorted  to  after  the  failure  of  high  forceps  or 
version.  If  delivery  be  urgently  demanded  in  such 
cases,  1  feel  that  it  is  better  to  perform  craniotomy 
than  to  subject  the  mother  to  any  risk  for  the 
sake  of  a  child  whose  life  has  already  been  com- 
promised. Moreover,  I  feel  that  it  should  not  be 
employed  in  cases  of  infection,  as  a  large  part  of 
the  fatal  results  recorded  in  the  literature  have 
occurred  in  that  class  of  cases." 


thin.  His  opinion  is  thai  there  is  no  warranl  I'm' 
the  removal  of  a  comparatively  healthy  gall-blad- 
der. 


In  an  article  in  the  Washington  Medical  Annals, 
Vol.  Ill,  No.  3,  July,  1909,  entitled  "Some  of  the 

Perplexing  Complications  Found  in  Gall  Stone 
Surgery,'"  Or.  I.  S.  Stone,  class  of  1872,  of  Wash- 
ington,  O.  C,  lays  emphasis  upon  the  following 
points:  The  diagnosis  of  gall  stone  diseases  is 
comparatively  easy  when  followed  by  jaundice,  and 
when  a  stone  is  found  in  the  stool;  otherwise  it  is 
difficult.  He  refuses  to  assent  to  the  statement 
that  pressure  over  the  gall  bladder  with  the  hand 
will  cause  pain  if  stones  are  present.  He  claims 
ulcer  of  the  stomach  or  duodenum  give  rise  to 
symptoms  simulating  gall-bladder  disease,  making 
a  positive  diagnosis  often  impossible.  The  con- 
tracted gall-bladder  has  given  the  writer  the  most 
difficulty   in    locating  both  before  and  after  opera- 


lien.  Hopkins  Can-.  M.  0.,  Portsmouth,  Va.. 
class,  1896,  reports  the  following  of  cases  of 
lupus,  epithelioma,  acne  and  nevus  successfully 
in- 1  with  X-ray  and  high  frequency  currents-. 

1  have  nothing  new  to  present,  but  desire 
to  show  the  good  results  that  have  followed  the  use 
of  the  X-ray  and  of  the  high  frequency  current  in 
lie  above  conditions,  which  have  often  proved  in- 
tractable and  been  a  source  of  considerable  annoy- 
ance to  the  physician  on  account  of  their  poor  re- 
sponse t"  the  methods  in  existence  before  the  ad- 
veit  of  these  new  agents. 

Lupus  Vulgaris. — The  patient  was  a  woman 
sixty  year.-  of  age,  in  a  fair  state  of  health.  The 
pari  affected  was  the  ear  and  an  area  of  two  inches 
below  and  behind  its  lower  border.  The  lobe  of 
the  ear  had  been  destroyed  and  the  ulcerative  pro- 
cess was  penetrating  deeply  at  the  junction  of  the 
ear  with  the  head.  There  was  intense  itching  and 
redness;  no  apple-jelly  tubercules  typical  of  this 
foi  in  of  lupus  were  present;  they  had  apparently 
been  destroyed  by  chemical  methods.  This  form 
nf  treatment,  however,  has  been  entirely  supplanted 
by  the  X-ray.  through  tin.'  use  of  which  brilliant 
results  are  obtained.  I  gave'  this  women  seances 
of  five  minutes'  duration,  alternating  the  tube  with 
the  high  frequency  current  every  other  day.  After 
the  first  exposure  the  itching  was  entirely  relieved. 
The  amount  of  X-rays  employed  was  just  sufficient 
to  lieht  the  tube  with  a  greenish  yellow  glow;  all 
the  time  the  reaction  was  kept  well  below  the  point 
of  active  dermatitis.  In  this  manner  tissues  of 
low  resistance  were  destroyed  without  affecting  the 
healthy  stroma.  By  the  continuous  use  of  these 
weak  exposures  for  a  period  of  two  months  the 
ease  was  entirely  cured. 

Epithelioma. — The  patient  was  a  woman  sidy 
years  old:  the  growth  was  a  so-called  crater-form 
epithelioma,  the  border  being  very  nodular  and  ele- 
vated, with  a  sharply  excavated,  deep,  central 
ulcer,  involving  the  left  side  of  the  nose.  In  this 
case  1  used  the  tube  exclusively;  the  seances  were 
of  eight  to  ten  minutes  duration  twice  a  week,  with 
the  tube  brought  to  a  greenish  yellow  glow.  A  fter 
ten  weeks  of  treatment  a  cure  was  affected. 

Acne  in.  a  young  man,  twenty-two  years  old. 
llis  face  was  covered  with  superficial  inflammatory 
papules  and  pustules,  associated  with   comedones. 


128 


THE  HOSPITAL  BULLETIN 


I  treated  him  with  the  ultra-violet  light,  ami  con- 
stitutional treatment  was  also  resorted  to.  The 
seborrhea  disappeared  first;  the  formation  of 
comedones  and  acne  lesions  gradually  ceased,  with 
diminution  of  the  size  of  the  sebaceous  follicles,  the 
pores  becoming  small,  and  the  texture  of  the  skin 
was  entirely  restored. 

Nevus  in  an  infant,  two  months  old.  located  on 
the  forehead,  extending  from  the  hair  to  the  bridge 
of  the  nose.  It  was  a  vascular  nevus  of  the  flat 
variety,  consisting  of  a  superficial  plexus  of  dilated 
capillaries.  I  treated  this  by  the  cataphoric 
method.  After  painting  the  nevus  with  sodium 
thylate,  it  was  made  to  penetrate  the  affected 
capillaries  by  the  high  frequency  current.  In  seven 
days  a  scab  had  formed,  and  in  twenty-one  days 
I  he  nevus  came  away  with  the  scab,  leaving  the 
skin  in  a  normal  condition,  with  the  exception  of  a 
slight  scar  that  was  scarcely  visible  in  thirty  days. 

Psoriasis. — This  was  a  case  of  the  acute  in- 
flammatory form  of  psoriasis.  The  lesions  were 
on  the  extensor  surfaces  of  both  forearms,  extend- 
ing from  the  elbow  to  the  wrist.  The  eruption  had 
the  characteristic  red  base,  slightly  elevated,  with  a 
sharply  circumscribed  border.  I  resorted  to  the 
high  frequency  current  exclusively,  and  with  the 
large  surface  electrode  made  applications  id'  five 
minutes'  duration  every  third  day.  After  five  such 
treatments  the  eruption  completely  disappeared. 


Rodent  Ulcers  of  the  Cornea 
(Moren's  Ulcer.) 

Robert  L.  Randolph,  class  of  188-1  (J.  A.  M.  A., 
July  2  f.  1909),  is  surprised  that  so  few  cases 
(thiity-five)   cases  of  corneal  nicer  (Moren's)  are 

reported  in  the  literature.  He  believes  it  is  due 
to  a  lack  of  recognition  upon  the  part  of  the 
ophthalmologist.  At  first  sight  this  corneal  ulcer 
does  not  differ  from  that  form  which  very  ophthal- 
mologist sees  now  and  again,  the  marginal  ulcer. 
One  feature  which  distinguishes  it  from  any  other 
ulcer  of  the  cornea  deeply  undermined  conjunctival 
edge  of  the  ulcer.  The  edges  of  marginal  ulcer 
an  also  undermined,  hut  owing  t  oa  better  blood 
supply  not  to  the  same  extent  as  the  borders  of 
rodent  ulcer.  Chronicity  is  an  important  point  in 
the  history  of  rodent  ulcer.  Average  length  of 
time  from  two  to  ten  months,  occasionally  the  con- 
dition last  for  more  than  a  year. 

It    is  a   mistage  to  think  that   the  affection  is 
painless,  for  it  is  characterized  by  frequent  attacks 


of  suffering  and  irritative  symptoms  generally. 
The  ulcer  shows  considerable  to  run  close  and 
parallel  to  the  limbus  of  the  cornea,  and  one  of  its 
peauliarities  is  to  clear  up  and  look  as  though  it 
would  he  completely  well  in  a  few  days,  when  a 
flesh  outbreak  would  occur.  The  diseased  surface 
is  crescentic  and  hare  id'  epithelium,  as  a  conse- 
quence o  fwhich  the  fluorescin  stain  takes  well. 
Wherever  the  process  has  spent  itself  the  cornea  is 
scarred.  The  disease  dies  out  in  most  cases  after 
the  entile  cornea  has  been  involved.  Usually  seen 
in  adults  over  40.  Men  more  prone  than  women. 
Its  etiology  is  unknown.  He  is  inclined  to  the 
view  that  it  is  of  bacterial  origin.  lie  believes 
after  two  months  if  the  ulcer  has  not  yielded  to 
active,  irritants  such  as  the  galvano  cautery  it  si 
l.eltci  to  these  applications  ami  resort  to  sail  solu- 
I  ion.  atropine  and  tonic  treatment. 


Doctor  Samuel  Theobald,  class  of  1867,  in  tin1 
duly  lo.  1909,  issue  of  the  Journal  of  the  Ameri- 
can Medical  Association,  relates  that  nearly  all 
the  ills  to  which  flesh  is  heir,  have  been  ascribed  to 
eyestrain  (Reflex  Aural  Neuroses  caused  by  Eye- 
strain), but  scant  consideration  has  been  given  to 
the  influence  which  it  exerts  on  the  auditory  ap- 
paratus. So  scant  indeed  that  he  can  find  no 
reference  to  it  in  the  titles  id'  papers  contained  in 
the  Imle'x-<  atalogue  of  the  Surgeon-General's  Lib- 
rary. Consequently  he  has  felt  it  incumbent  upon 
himself  to  relate  his  experience  in  the  matter.  In 
enumerating  the  less  common  consequences  of  eye- 
strain he  mentions  tinnitus  aurium,  others  which 
hi  has  observed  are  a  "muffled"  or  "stuffed"  sen- 
sation in  the  ear,  pain,  not  severe,  impairment  of 
healing.  Whether  vertigo  associated  with  eye- 
strain, deserves  to  be  regarded  as  an  aural  reflex, 
he  is  not  prepared  to  say.  though  it  seems  not  at  all 
improbable  that  the  derangement  that  gives  rise 
to  it  is  in  the  semi-circular  canals. 

The  evidence  in  favor  of  the  ocular  origin  of  the 
aural  sensations  enumerated  is,  first,  their  disap- 
pearance after  relief  of  the  eyestrain;  second,  that 
the  car  affected — for  the  sensations  were  com- 
monly unilateral — was  usually  on  the  side  of  the 
more  troublesome  eye;  and  third,  that  they  often 
became  more  pronounced  wben  the  eyestrain  was 
most  annoying.  The  ocular  fault  often  present 
was  astigmatism. 

He  appends  to  the  article  the  notes  of  four  of 
the  most  striking  of  the  cases  which  have  come 
under  his  obsen ation. 


THE  HOSPITAL  BULLETIN 


129 


THE  HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

EDITED    BY 

A    COMMITTEE    OF   THE    HOSPITAL    STAFF 


PUBLISHED    BY  THE 

HOSPITAL  BULLETIN  COMPANY 
University  of  Maryland 


Business  Address, 
Editorial  Address, 


.     .       Baltimore,  Md. 
University  of  Maryland 


Baltimore,  Md.,  September  15,  1909 


THE  COURSE  OF  MEDICAL  INSTRUCTION. 
THE  IMPROVEMENTS  NEEDED. 

The  great  amount  of  attention  which  has  been 
given  in  recent  years  to  laboratory  instruction  in 
the  education  of  the  medical  student  lias  overshad- 
owed, in  a  measure,  the  didactic  and  clinical  work 
which  formerly  made  up  the  courses  of  instruc- 
tion in  our  medical  schools.  The  brilliant  results 
which  have  followed  from  laboratory  studies,  the 
scientific  cast  which  they  give  to  the  mind  of  the 
student,  the  cultivation  of  his  faculties  of  obser- 
vation and  research,  and  clearer  insight  into  the 
etiology  and  treatment  of  disease,  have  made  the 
laboratory  the  keystone  which  gives  support  to  the 
modern  system  of  education  in  medicine.  The  lab- 
oratory has  not  only  come  to  stay,  but  is  destined 
to  exercise  a  much  larger  place  in  the  training 
of  the  medical  student.  The  word  laboratory 
must  be  considered  in  its  broadest  sense — not  as 
a  room  equipped  simply  with  microscopes  where 
histology  and  pathology  are  studied,  but  courses 
of  instruction  conducted  in  anatomy,  physiology, 
chemistry  and  clinical  medicine  and  surgery  where 
laboratory  methods  are  employed.  The  laboratory 
is  the  place  where  painstaking  observations  are 
made,  where  health  and  disease  are  studied  side 
by  side  with  a  scientific  formula  and  not  with 
loose  and  easy  methods. 

The  course  of  medical  instruction  is  rapidly  con- 
forming to  the  laboratory  conception.  The  text- 
book, the  didactic  lecture,  the  quiz  and  the  oral 
examination  belong  largely  to  the  pedagogue; 
these  have  a  minor  place  in  the  curriculum  of 
the   future  which  must  consign  to  the  junk  shop 


much  rubbish  which  is  now  made  to  take  the 
place  of  more  valuable  material.  Knowledge  of 
many  subjects,  formula'  ami  things  is  not  so 
much  needed  by  the  physician  anil  surgeon  as  in- 
telligence, correct  judgment,  scientific  ability,  the 
faculty  of  seeing  and  appreciating  the  relations 
id'  things  and  id'  arriving  at  practical  results. 
In  the  education  of  the  medical  student  his  knowl- 
edge of  subjects  should  be  exact,  but  this  knowl- 
edge should  be  of  that  character  which  is  in  con- 
stant use,  which  has  direct  relation  to  the  prac- 
tice of  that  branch  or  to  those  branches  of  science 
in  which  he  is  chiefly  employed.  Much  of  the 
materia]  which  is  now  crammed  into  the  mind 
id'  the  student  could  he  and  should  be  cut  out  if 
the  aim  of  the  student's  future  work  can  be  as- 
certained. In  every  class  of  medical  students 
there  are  not  a  few  men  who  have  definite  courses 
in  view;  a  few  are  destined  to  follow  the  scien- 
tific laboratory  —  pathological,  physiological  or 
chemical ;  a  few  others  specialize  in  medicine, 
surgery  or  their  minor  fields,  whilst  the  larger 
majority  will  express  their  purpose  of  engaging 
in  general  practice.  It  seems  clear  that  a  course 
of  education  which  holds  an  entire  class  to  the 
same  line  of  study,  making  no  exceptions  for  the 
laboratory  man  or  the  clinician  is  following  old 
and  impractical  methods.  The  time  is  fast  com- 
ing when  such  systems  must  give  way  to  broader 
and  more  enlightened  views.  Why  postpone 
specialization  in  medical  study  until  after  gradua- 
tion, when  it.  might  be  inaugurated  with  marked 
advantage  to  the  student  during  the  years  of  prepa- 
ration for  the  doctorate? 

After  the  fundamental  sciences  have  been  well 
taught  the  field  of  work  might  well  be  narrowed 
to  cut  out  on  the  one  hand,  or  to  emphasize  on 
the  other,  those  lines  of  work  which  may  be  un- 
necessary or  necessary  to  the  man  in  his  future 
career.  The  most  marked  success  now  being  made 
by  men  in  all  avocations  and  professions  will  be 
found  in  that  class  who  do  not  possess  so  wide 
and  varied  a  knowledge  of  many  things  as  an 
accurate,  practical  and  clear  knowledge  of  the 
work  in  which  they  are  engaged. 

Knowledge  is  not  skill,  nor  is  it  wisdom.  It 
is  only  a  valuable  asset  when  it  is  used  skillfull)' 
and  wisely.  The  time  expended  in  acquiring 
knowledge  will  be  well  spent  or  poorly  spent  in 
proportion  as  this  knowledge  is  made  use  of  by 
the   individual,    hut   a    training   which   stimulates 


130 


THE  HOSPITAL  BULLETIN 


a  mind  to  think,  to  observe,  to  judge,  and  to  act, 
will  always  give  an  asset  to  the  individual  which 
will  pass  at  its  par  value  in  any  market.  If  the 
education  of  the  student  enables  him  to  acquire 
a  habit  of  mind  which  tits  him  to  see  and  judge 
facts  in  their  true  relations,  to  know  the  true 
from  the  false,  to  discriminate  and  adjust,  to  have 
loyalty  and  mental  endurance,  the  highest  stand- 
ard of  instruction  has  been  reached. 


THE   PHYSICIAN   IX    POLITICS. 

It  is  unfortunate  for  the  medical  profession 
and  still  nunc,  we  believe,  for  the  public  inter- 
ests, that  I'ew  physicians  are  found  in  legislative 
bodies,  either  state  or  national.  These  few, 
as  a  rule,  are  young  men  seeking  local  popu- 
larity, or  older  men  retired  from  the  active  prac- 
tice of  medicine  or  engaged  in  othei  pursuits. 
There  is  an  apparent  antagonism  between  the 
active  practice  of  medicine  anil  the  occupancy 
of  public  office.  The  constant  demands  upon  the 
time  of  the  physician  engaged  in  a  busy  profes- 
sional work  make  the  holding  of  a  public  office 
a  question  of  personal  sacrifice  of  business  which 
hut  few  men  will  agree  to.  The  physician  in 
politics  must  either  he  a  man  who  is  simply  in- 
terested in  public  matters  without  holding  pub- 
lic office  or  the  man  who  accepts  public  office  to 
the  neglect  of  his  professional  interests.  The  re- 
sult of  this  condition  of  things  has  tended  to  lower 
the  professional  standard  of  the  physician  in  poli- 
ties in  the  respect  and  confidence  not  only  of  his 
professional  brothers,  but  of  Ins  patients  and  neigh- 
bors. There  is  no  substantial  reason  why  this 
feeling  should  exist  and  it  is  unfortunate  not 
only  for  the  medical  profession,  but  for  the  pub- 
lic, that  it  does,  since  it  has  deprived  the  state 
and  nation  of  a  class  of  men  whose  training  and 
experience  could  have  been  made  extremely  valu- 
able in  the  public  service.  It  has  forced  the  lead- 
ing members  of  the  profession  of  recognized  pro- 
fessional ability  and  large  accomplishments  to 
take  no  active  part  in  the  making  of  useful  laws 
and  in  promoting  the  best  interests  of  citizen- 
ship by  an  active  co-operation  in  civic  affairs. 

In  looking  over  our  numerous  state  and  national 
legislative  bodies  one  is  struck  with  the  small 
representation  of  the  medical  profession  in  con- 
trast with  that  of  other  professions  and  occupa- 
tions.   Lawyers,  capitalists,  bankers,  farmers  and 


even  clergymen,  are  more  largely  represented  in 
these  bodies  than  are  physicians,  scientists  and 
educators;  men  who  by  training  and  mental  dis- 
cipline are  most  eminently  fitted  for  public  lib' 
and  public  service.  In  the  present  Senate  of  the 
United  States  there  is  only  one  trained  physician, 
and  it  is  well  known  how  wisely  and  well  he  has 
served  the  nation.  In  the  House  of  Representa- 
tives one  can  count  on  his  fingers  all  the  physi- 
cians in  this  body  ami  yet  find  no  man  who  has 
made  distinction  in  his  profession  outside  his  own 
district. 

In  the  Cabinet  we  fail  to  find  in  the  bmg  list 
of  men  who  have  been  advisers  of  tin  President 
the  name  of  a  single  physician.  In  the  early  his- 
tory  of  the  Republic  Benjamin  Rush  not  only 
-i  rved  the  nation  with  eminent  ability,  but  was 
a  distinguished  ornament  to  the  profession  of 
medicine,  and  taught  the  lesson  that  the  physi- 
cian in  politics  was  equally  skilled  in  the  duties 
of  the  sick  mom.  He  found  ample  time  to  attend 
his  patients,  to  contribute  to  the  literature  of  his 
profession  and  to  serve  the  nation  in  the  most 
critical  period  of  its  existence. 

Benjamin  Franklin,  philosopher,  scientist  and 
statesman,  whilst  not  a  physician,  demonstrated 
that  wide  and  varied  talents  enlisted  in  the  pub- 
lic service  gave  dignity  and  authority  not  only  to 
the  man.  but  to  positions  he  filled  in  public  office. 

In  Cteat  Britain  one  cannot  but  be  struck  with 
the  small  part  the  medical  profession  has  played 
in  the  political  history  of  this  great  nation.  Whilst 
Harvey,  dinner.  Hunter.  Simpson.  Lister  and 
many  noted  men  have  brought  great  honor  and 
glory  to  the  English-speaking  race,  we  find  no 
Harvey  in  Parliament  making  laws  ami  no  Jen- 
ner  in  the  House  of  Lords  contending  for  estab- 
lished privileges.  The  physician  in  politics  in 
Great  Britain  has  made  no  distinction  and  has 
tendered  but   little  public  service. 

In  France  both  physician  and  scientist  have 
engaged  with  striking  loyalty  and  efficiency  in 
public  service  and,  perhaps,  in  no  nation  has  the 
medical  profession  been  more  largely  and  ably 
represented  in  legislation  and  in  administration. 
The  French  people  have  dignified  both  medicine 
and  general  science  by  the  high  regard  it  bestows 
upon  men  who  became  eminent  as  investigators 
or  as  leaders  of  thought  ami  action.  She  has 
honored  with  the  highest  public  office  many  of 
her  most  noted  physicians.     In  Germany  the  late 


THE  HOSPITAL  BULLETIN 


131 


Prof.  Virehow  is  a  striking  illustration  of  the 
greatest  of  scientists  and  the  greatest  of  citizens. 
It  is  doubtful  whether  his  contributions  to  pa- 
thology, which  have  become  the  property  of  the 
entire  world,  are  held  in  higher  esteem  by  the 
German  people  than  his  civic  virtues,  his  manly 
independence  and  profound  patriotism. 

The  German  people  know  that  Virchow  loved 
and  served  Germany  as  much  as  he  loved  science 
and  that  he  gave  his  best  labors  to  both.  With 
these  general  statements  of  conditions  which  have 
influenced  the  participation  of  the  physician  in 
politics,  it  is  pertinent  to  ask  whether  these  con- 
ditions should  continue  or  whether  the  time  has 
not  come  for  larger  and  more  liberal  views  on 
the  subject.  In  an  age  of  such  progress  as  the 
world  now  enjoys  men  of  training,  of  talent  and 
of  fitness  are  needed  in  every  walk  of  life.  The 
functions  of  government  are  becoming  more  and 
more  complicated  each  day.  The  laws,  customs 
and  business  interests  of  the  people  are  being 
changed  to  meet  industrial  and  social  establish- 
ments which  spring  up  over  night  and  threaten  the 
stability  of  older  thought  and  action.  This  social 
and  industrial  evolution  brings  money  and  class 
distinction  into  the  limelight,  and  makes  organi- 
zation and  co-operation  essential  to  an  honest 
and  efficient  administration  in  civil  government. 
The  men  who  control  political  parties,  who  make 
our  laws  and  who  govern  the  people  are  largely 
put  in  these  positions  of  trust  and  responsibility 
through  influences  organized  and  controlled  by 
corporate  or  personal  interests.  The  people  at 
large  who  vote  and  make  majorities  are,  as  a  class, 
indifferent  to  general  results  so  long  as  they  are 
not  personally  disturbed  in  their  property  inter- 
ests. A  law,  however  unjust  or  bad,  is  not  vicious 
except  to  the  individual  who  is  prejudicially  ef- 
fected by  it.  A  high  tariff  is  only  detested  by 
people  who  seek  the  benefits  of  the  low  tariff. 
In  other  words,  the  question  of  legislation  is  very 
largely  determined  by  personal  interests  and  con- 
siderations, and  these  matters  usually  influence 
the  election  of  men  who  make  our  laws  and  govern 
our  affairs. 

So  long  as  the  people,  as  a  body,  do  not  con- 
cern themselves  in  a  serious  way  about  political 
questions,  just  so  long  will  legislation  follow  the 
channels  made  by  personal  interests.  If  able 
and  efficient  men  are  so  much  interested  in  their 
private  affairs  as  to  be  unwilling  to  render  public 


service,  what  right  have  they  to  expect  personal 
consideration  by  men  who  may  have  their  own 
persona]  interests  in  direct  conflict  with  theirs? 

If  the  medical  profession  desires  legislation 
along  lines  in  accord  with  the  highest  public  and 
professional  interest,  it  must  assert  its  influence 
through     persona]     representation     in     legislative 

bullies. 

Some  of  its  best  men  must  be  willing  to  make 
a  personal  sacrifice  by  accepting  public  office,  and 
by  lending  their  best  influence  in  behalf  of  the 
highest  citizenship.  If  the  profession  has  no 
civic  pride  or  loyalty  and  seeks  to  escape  persona] 
responsibility  in  public  service,  it  should  mil 
complain  if  legislation  does  not  go  its  way. 

Xi)  body  (if  men  is  in  better  position  to  direct 
the  public  mind  and  to  promote  the  highest  stand- 
ard of  citizenship  than  are  medical  men.  They 
know  the  needs  of  the  people  and  are  nearer  to 
the  hearts  of  the  people  than  any  other  class.  It 
is  up  to  the  profession  to  say  whether  the  physi- 
cian in  politics  shall  command  the  co-operation 
and  respect  of  his  brother  physicians  when  he 
consents  to  render  a  public  service,  or  whether 
his  efficiency  shall  lie  weakened  by  indifference 
and  adverse  criticism.  T.  A.  A. 


CORRESPONDENCE 

AMERICAN   ASSOCIATION    OF    CLINICAL 

RESEARCH. 
Editor  Hospital  Bulletin, 
Dear  Sir  : 

There  is  a  movement  on  foot  to  establish  an 
American  Association  of  Clinical  Research  for 
(be  purpose,  first,  of  ascertaining  the  present  ex- 
act status  of  clinical  medicine  and  surgery,  and, 
secondly,  of  advancing  clinical  medicine  and  sur- 
gery, by  the  conjoined  clinical  method  or  any 
other  method  that  will  insure  exact  and  abiding 
results. 

Will  you  have  the  kindness  to  publish  the  ac- 
companying open  letter  in  the  next  or  the  earliest 
possible  issue  of  your  Journal? 

The  meeting  is  called  for  October  27  next,  and 
your  assistance  in  calling  attention  to  this  meet- 
ing sufficiently  early  will  be  highly  appreciated 
as  an  effort  to  help  the  cause  of  scientific  medi- 
cine  and    surgery. 


132 


THE  HOSPITAL  BULLETIN 


OPEN   LETTER. 
Dear  Doctor: 

A  meeting  of  physicians  and  surgeons  interested 
in  Scientific  Clinical  Research  is  called  for  Wed- 
nesday, October  21,  190&,  at  John  Ware  Hall. 
Boston  Medical  Library,  No.  8  Fenway.  Boston, 
Massachusetts.  The  meeting  will  come  to  order 
at  in  A.  M.,  and  carry  its  sessions  through  Wed- 
nesday, and.  if  necessary,  through  Thursday  and 
Friday. 

'Flu'  object  id'  the  meeting  is. 

Fust,  to  establish  an  American  Association  id' 
Clinical   Research; 

Secondly,  to  establish  clinical  research  on  an 
incontrovertible  scientific  basis   in   hospitals:   and 

Thirdly,  to  institute  an  American  Journal  of 
Clinical  Research,  in  which  the  work  of  members 
of  the  American  Association  and  of  others  doing 
clinical   research  work  in  a  scientific  manner  shall 

be    published. 

Yon  and  your  friends  are  herewith  cordially 
invited  to  participate  in  this  meeting  and  in  the 
proposed  movement  of  scientific  clinical   research. 

This  invitation  is  extended  to  all  physicians 
and  surgeons  whose  interest  goes  beyond  the  im- 
mediate ease  work  of  ordinary  clinical  societies: 
and  it  is  hoped  that  the  invitation  will  be  ac- 
cepted by  all  medical  practitioners,  irrespective 
of  their  present  medical  affiliations,  who  can 
appreciate  the  necessity  for  establishing  on  an 
incontrovertible  scientific  basis  the  certainties  and 
limitations  of  the  present  practice  id'  medicine 
and  surgery  before  attempting  to  add  to  the  al- 
.  ready  large  ami  cumbersome  field  of  medicine. 

The  American  Association  of  Clinical  Research 
is  not  intended  to  disturb  the  present  medical 
affiliations  of  its  members  nor  to  interfere  in 
the  very  least  with  the  duties  they  owe  and  the 
privileges  they  enjoy  by  virtue  of  their  affiliation 
with   any   existing  national   medical  body. 

The  Americal  Association  of  Clinical  Research 
is  to  take  cognizance  id'  the  fact  that  the  clinic 
requires  cold  facts  and  conclusive  methods,  and 
upon  these  fundamental  requirements,  the  struc- 
ture and  the  work  of  the  American  Association 
of  Clinical  Research  are  to  be  built. 

It  is  of  the  utmost  scientific  importance  to  es- 
tablish conclusively  all  that  is  at  present  true 
in  medicine  and  surgery,  and  only  upon  such 
proved  knowledge,  to  base  any  further  advance- 
ment. The  clinic  deals  with  clinical  entities  and 
not,  like   the   laboratories,   with   parts  as  entities. 


Therefore,  clinical  research  differs,  and  must 
differ,  from  experimental  laboratory  researches. 
Clinical  research  must  consider  clinical  entities, 
and  when  considering  parts,  it  must  consider 
them  only  as  parts  and  not  as  whole-.  All  that 
subserves  the  object  id'  obtaining  and  investi- 
gating clinical  fact-  and  principles  belongs  to 
clinical  research  and  the  laboratory  is  a  part  of 
the  means  of  clinical  research,  hut  only  a  part. 
The  crux  of  the  matter  appears  to  be  that 
experimental  laboratory  proof  is  not  sufficient 
clinical  proof.  In  order  to  advance  in  an  irre- 
sistible line,  clinical  research  must  be  based  on 
a  conclusive  form  or  method  of  clinical  proof. 
In  experimental  proof,  we  dislocate  a  pari  from 
a  whole  ami  attempt  to  prove  the  whole  from  the 
pait.  as  though  a  dislocated  part  could  always 
prove  the  whole.  Or  we  attempt  to  prove  facts 
in  one  species  by  facts  in  another  species,  as 
though  the  two  species  were  identical.  For  in- 
stance, the  experiments  made  on  animals  to  elu- 
cidate certain  elements  of  fever  bring  out  a  fact 
of  almost  insurmountable  difference  between  man 
ami  the  lower  animals,  the  fact  that  man  has 
associated  with  the  nakedness  id'  his  body  a  highly 
perfected  power  for  regulating  his  temperature, 
a  highly  developed  vasomotor  system  and  a  vast 
array  of  sweat  glands,  a  characteristic  complex 
of  things  which  apparently  no  other  species  of 
animal  life  presents.  Experiments  made  on  ani- 
mals to  prove  febrile  or  other  clinical  phenomena 
in  man.  may  he  suggestive,  but  for  obvious  rea- 
sons cannot  be  conclusive.  To  prove  observations 
in  man.  the  observations  must  be  made  on  man 
and  not  on  animals.  But  observations  on  man 
even  are  not  necessarily  conclusive.  Individual 
observations  on  man  cannot  be  conclusive,  because 
the  same  experience  cannot  be  repeated,  and  when 
we  prove  by  numbers,  we  compare  similar  but 
not  identical  experiences.  Analogy  is  not  con- 
clusive proof.  Identity  alone  is  conclusive  proof; 
but  since,  in  medicine,  identical  experiences  can- 
not he  lepeated,  we  must  provide  simultaneous 
identical  experiences  in  order  to  have  proof  by 
identity.  Clinical  proof  is  conclusively  estab- 
lished when  all  observations  and  experiments  are 
made  conjointly  by  at  least  two  competent  men. 
preferably  of  opposite  ideas,  at  the  same  time. 
Conjoined  critical  observation  and  experiment,  at 
the  bedside  and  in  the  laboratory,  as  may  be  re- 
quired, furnish  simultaneous  identical  experiences, 
the  proof  proceeding  on  the  principle  that  a  whole 


THE  HOSPITAL  BULLETIN 


133 


cai]  In1  proved  only  by  the  whole  and  no!  by  dis- 
located parts. 

These  and  other  weighty  questions  awail  your 
assistance  for  a  necessary  solution.  The  benefit 
that  will  accrue,  both  to  medicine  in  particular 
.•mil  to  the  medical  profession  and  humanity  at 
large  in  general,  from  a  satisfactory  establishment 
of  scientific  clinical  research,  can  be  easily  sur- 
mised. Come  prepared,  yourself  and  your  friends, 
to  give  to  this  matter  your  mature  convictions 
and  your  personal  assistance.  Only  from  a  criti- 
cal interchange  of  critically  acquired  opinions, 
can  we  hope  for  clearness  and  for  the  clarifica- 
tion of  the  medical  atmosphere  now  charged  with 
confusion   and    indifference. 

Your  communication,  indicating  your  interesi 
and  ymir  expectation  of  being  present  at  the  meet- 
ing in  Boston  on  October  27,  next,  is  eagerly 
awaited,  and  on  receipt  of  the  expression  of  your 
inteiert,  further  developments  will  be  communi- 
cated  to  you  personally  in  due  time. 

1'lease    addiess    your    communications    at    tlic 
earliest    possible   date   directly   to  dames   Krauss, 
M.     I).     119    Boylston    Street,    Boston,    Mass. 
Yours   fraternally, 
(Signed)     .Tames  Krauss,  M.  D., 
Chairman    Committee   American    Association 

< 'I i /ileal  Research. 
llii   Boylston    Street,   Boston. 
August  18,  1909. 


MEDICINE    IX    GENEVA   AND   THE    CAL- 
VIN FETES. 
To  the  Editor  of  the  Hospital  Bulletin: 

Called  upon  to  represent  the  University  of 
Maryland  on  the  occasion  of  the  University 
Jubilee  at  Geneva,  Switzerland,  I  found  myself 
eaily  in  July  comfortably  established  at  the  Na- 
tional Hotel,  a  hostelry  charmingly  situated  on 
the  margin  of  the  Lake  of  Geneva.  Arriving 
somewhat  ahead  of  time,  owing  to  misleading  ac- 
counts in  the  Swiss  papers  as  to  the  order  of 
events,  I  was  ahle  to  see  a  little  of  two  other 
fetes  which  took  place  about  the  same  time,  the 
Commemoration  of  the  Foundation  of  the  Geneva 
Protestant  Church,  and  the  laying  of  the  corner- 
stone of  the  Monument  to  the  Reformers,  and  the 
350th  anniversary  of  the  founding  of  the  Academy 
or  College  by  John  Calvin  and  Theodore  de 
Beye,  which  latter  took  place  on  June  5,  1559. 
Strictly  speaking,  Geneva  cannot  lay  claim  to 
being  a  very  old  University.     Recent  writers  put 


the   date    at    1875   or    1876,   so    that    it    does   not 
compare  in  age  with  many  of  our  American  uni- 
versities,  nor   can    it    he   mentioned    in   the   same 
breath  with  those  of   Bologna,   Paris  and  Oxford, 
which    are    certainly    800    years    old.       Neverthe- 
less   there    is    no    doubt    that    the    "Academies" 
founded    in    1559    by    Calvin,   became   eventually 
the    University  of  Geneva,  and    (hat   in  those  re- 
mote times  Calvin  was  lecturing  to  more  than   a 
thousand    students,   among   his   pupils   being  John 
Strong,  the  Scottish    Reformer;  Thomas   Bodley, 
the  founder  of  the   Bodleian    Library  at  Oxford, 
and    dean   Jacques     Rousseau,     whose     writings, 
more  than  any  others,  inspired  the  French   Revo- 
lution.     Nor  can   there  he  any  doubt   that   during 
the  comparatively   few  years  of  Calvin's   life   in 
Geneva   he  exercised   an    influence   on   general   edu- 
cation  on   the  Christian    Religion,   anil   on   the   po- 
litical  life  of  the  State,  thai    many   have  been  dis- 
posed   to    underestimate.      Calvin    and    de    Beye, 
the    first    Restorers    of    the    Academy,    were,    in 
many  respects,  the  most  remarkable  men  of  their 
time.      Calvin    was   never   a    popular   man   in    the 
sense   in  which  we  use  the  word  :  other  Reformers 
were    certainly    of    far    more    lovable    disposition, 
hut    he    had    remarkable    endowments,    and    pos- 
sessed  great    strength   of   character.     Of   a   clear 
and   logical   mind,  he  had   the   power  of  expressing 
himself,    both    as    a    writer    and    speaker,    and    a 
style  of  composition  that  has  seldom  been  squalled. 
He  was  also  a  horn  teacher,   having  not  only  the 
ability  to   attract    large   audiences,   hut   to  retain 
their  attention  and  interest.     In  de  Beye  or  Beya, 
as    he   is    perhaps   more   often    called,    Calvin   had 
a    coadjutant,    committed    to    his    view,   both   will- 
ing and   ahle   to  carry  out   the  details  of   instruc- 
tion under  orders  from  his  chief.  The  martyrdom 
of  Michael   Servetus,   the  distinguished  physi- 
cian and  anatomist,  must  he  judged   in  the  light 
of    Calvin's    character    and     the    spirit    of    those 
times  when  discoveries  in   medicine   were  viewed 
with    alarm.      After    all.    as    a     man    said    to    me 
when   discussing  the   question,  "the   other   fellows 
(meaning  the  Catholics)   would  have  burned  him 
if  they  had  the  chance."     Death  at  the  stake  was 
to    the    popular   mind    a    proper    punishment    for 
the  man  who  held  such  heterodox  opinions. 

A  fact  that  interests  us  Americans,  especially 
where  new  universities  are  springing  up,  or  are 
made  by  associations  of  heterogeneous  elements, 
that  lose  much  of  their  efficiency  through  lack 
of  co-ordination,  is  that  Calvin  and  De  Beye  had 


134 


THE  HOSPITAL  BULLETIN 


from  the  first,  even  in  their  earlier  times,  when 
the  Academy  was  started,  the  idea  of  what  a 
University  should  he.  Though  they  hail  neither 
the  qualified  teachers  or  the  funds  to  carry  out 
their  ideas,  they  laid  the  cornerstone  for  the  I'ni- 
versity  of  Geneva  on  a  solid  foundation.  Their 
personal  qualities  were  their  capital,  for  they 
had  neither  laboratories,  museums,  or  elaborate 
physical  appliances.  To  them  is  due  the  in! in- 
duction of  class  studies  into  general  education. 
Dividing  the  students  into  groups,  according  to 
their  ability  to  assimilate,  lather  than  accord- 
ing to  age,  led  to  the  "promotions"  which  exist 
under  the  same  name  today  in  the  University  of 
Geneva.  "Promotions"  according  to  the  Swiss 
idea  is  the  advancement  of  students  from  a  lower 
to  a  higher  class,  after  passing  test  examinations. 
Previous  to  this  introduction  of  graded  courses, 
students  were  taught  in  a  mass,  without  regard 
to  age  or  qualifications. 

In  1533  Calvin  had  been  the  central  figure 
of  the  Reformation  in  France,  his  native  coun- 
try. He  was  then  ".' f  years  of  age.  Three  years 
later — in  1536 — he  published  his  "Institutes  of 
the  Christian  Religion."  In  153?  he  settled  in 
Geneva  and  lived  there  until  his  death  in  1564, 
at  the  comparatively  early  age  of  55.  During 
most  of  his  life  he  was  a  great  sufferer,  his  chief 
ailments  being  consumption  and  stone  in  the 
bladder. 

Fiske  had  called  him  the  Father  of  Coligny, 
William  the  Silent  and  Oliver  Cromwell.  And 
this  judgment  of  him  seems  to  have  influenced 
the  committee  which  had  in  hand  the  planning 
of  the  Reformer's  Monument,  the  cornerstone  of 
which  was  laid  opposite  the  University,  with  much 
ceremony,  on  duly  (i.  This  monument,  when  com- 
pleted, will  represent  in  colossal  size  Farel  the 
Reformer,  Calvin,  De  Beye  and  John  Strong,  while 
thinking  them  on  either  side  will  lie  smaller  figures 
of  Oliver  Cromwell,  William  the  Silent,  Frederick 
William  of  Brandenburg  and  our  American 
linger  Williams. 

It  was  noticeable  that  in  all  three  celebrations 
Calvin  was  the  central  figure.  The  people  both 
of  city  and  State  appeared  to  have  forgotten  his 
seeming  intolerance  and  tyranny,  or  felt  that  they 
hail  been  sufficiently  expiated  by  the  monument 
they  had  recently  erected  to  the  great  Servetus, 
and  it  was  none  the  less  a  little  surprising  to 
the  foreign  delegate  to  hear  Calvin  lauded  by 
Protestants    and    Catholics    alike.      Deucher,    the 


venerable  President  of  the  Swiss  Republic  and  a 
Catholic,  in  an  eloquent  address  at  the  dinner 
given  by  the  University,  spoke  of  Calvin  as  the 
man  who  taught  citizens  to  he  conscientious  and 
moral,  and  on  the  same  occasion  other  Stale  offi- 
cials, also  Catholics,  credited  him  with  an  in- 
fluence lor  good  which  they  hoped  might  live. 
To  the  modern  Swiss  Calvin  is  the  Washington, 
to  whom  they  owe  their  present  democratic  form 
of  government. 

The  University  of  Geneva  came  early  into 
prominence  through  the  number  and  ability  of 
its  theologians,  later  through  it>  departments  of 
Law.  Philosophy  and  Literature.  The  School  of 
Medicine  is  of  comparatively  recent  creation, 
though  among  its  professors  have  been  Carl 
Vogt  and  Edward  Clapareda,  comparative  anato- 
mists; Harmon  Fol,  the  embryologist,  and  Sigis- 
inund  Laskowski,  the  anatomist.  Its  present 
teachers  of  practical  medicine  and  surgery  are 
unknown  to  us.  hut,  alter  all,  Geneva  is  a  city 
whose  population  in  1907  was  not  more  than 
1 'in, lino.  This  is.  perhaps,  the  reason  the  United 
States  had  among  its  29  delegates  only  two  medi- 
cal men.  Dr.  W.  II.  Welsh,  representing  the  Car- 
negie [nstitution,  and  myself.  Most  of  the  dele- 
gates were  theologians  of  various  sects.  Perhaps 
the  most  interesting  and  noteworthy  ceremony 
was  held  in  the  old  St.  Peter's  Cathedral  on  July 
8,  when  delegates  representing  24  countries,  and 
•-''.'ii  universities,  learned  societies  or  associa- 
tions presented  their  addresses  before  an  audi- 
ence that  filled  the  building  to  overflowing. 
Dressed,  the  greater  number  in  their  academic 
gowns,  or  robes,  representative  of  an  office  or  so- 
ciety, the  brilliant  display  of  color  made  a  mosl 
effective  picture  against  the  sombre  background 
of  the  grey  old  Cathedral.  Each  delegate,  as 
he  was  called,  advanced  to  the  rostrum,  addressed 
a  few  complimentary  words  to  the  audience,  and 
handing  his  written  address  to  the  Rector,  shook 
hands  with  him.  and  then  retired  to  stand  again 
with  his  delegation  until  each  of  its  number  had 
been  heard  from,  when  they  returned  to  their 
seats  and  gave  place  to  the  next  delegation. 

flench  being  the  official  language  of  the  Uni- 
versity, most  of  the  delegates  spoke  in  that  lan- 
guage. Occasionally  German  was  used,  and  one 
delegate  spoke  in  Latin. 

Baltimore  and  Washington  were  the  only  cities 
of  our  States  represented  by  medical  delegates. 
Other  representatives  of  our  huge  cities  were  a 


THE   HOSPITAL  BULLETIN 


135 


number  of  Presidents  of  Colleges  and  Seminaries, 
and  men  of  note  generally.     The  complimentary 

deg s  of  Doctors  of  Medicine,  cansea  honoraris, 

were  33  in  number,  one  only  coming  to  the  United 
States.  It  was  conferred  upon  Loeb,  of  Cali- 
fornia, presumably  for  his  work  in  physiology. 
Among  those  honored  were  M.  Cewire,  of  Paris. 
for  his  discoveries  of  radia,  active  substances, 
and  his  work  on  radium;  Dejerine,  of  Paris,  for 
his  work  on  the  anatomical  changes  in  diseases 
of  the  nervous  system;  Dufour,  the  celebrated 
oculist  of  Lausanne  and  Carre  of  St  Gall,  for 
his  works  on  the  bacteriology  of  tuberculosis  af- 
fections; Van  Gebuchten,  of  Lourain,  Belguim, 
for  Ins  researches  on  the  anatomy  "I*  the  central 
nervous  system;  Golgi,  of  Paris,  for  his  researches 
on  the  structure  of  nerve  cells;  Lister,  for  his 
antiseptic  methods;  Pawlof,  of  St.  Petershurg, 
for    his    discove  to    the    functions    of    the 

stomach;  Sahli,  of  Berne,  for  Lis  noti  s  on  Inter- 
nal .Medicine;  Waller,  of  England,  for  his  studies 
on  the  physiology  of  bees.  Among  others  hon- 
order  were  Guyot,  the  French  surgeon;  Haeckel, 
of  Jena,  the  comparative  anatomist:  Kollmann, 
the  embryologist,  of  Bales;  Kronecker,  the  physi- 
ologist, of  lie! ne;  Recklinghausen,  the  bacteria 
pathologist,  of  Strassberg,  and  Ketzius,  the  his- 
tologist,  of  Stockholm.  Original  work,  especially 
in  anatomy  or  physiology,  seemed  to  be  regarded 
as  the  most  worthy  of  honor. 

Delegates  and  noted  guests  to  the  ciumbeT  of 
over  400  were  entertained  by  the  University,  city 
and  State,  acting  jointly.  The  fetes  as  a  whole 
began  on  duly  26  and  continued  without  inter- 
ruption until  the  nighf  of  the  loth,  when  a  grand 
"Commers"  by  the  students  brought  the  festivi- 
ties to  a  close  in  a  blaze  of  glory.  Nothwith- 
Btanding  most  unpropitious  weather  during  the 
Jubilees,  the  final  verdict  will  he.  I  am  sine. 
that  the  fetes  were  a  success.  The  elaborate 
entertainments  that  were  provided  day  after  day 
and  the  generous  hospitality  of  our  hosts  will 
he  long  and  pleasantly  remembered,  both  by  dele- 
gates  and    truest-. 

Thomas  G.  Satterthwaite,  M.  D.,  LL.  I).. 
;   Hast  80th  street  New  York  City. 


ii  of  John  W.  ami  Sarah  J.  Ridgely  Wilson.  His 
earlier  education  was  obtained  in  the  public  schools 
of  Baltimore  and  Milton  Academy,  his  medical  in 
the  University  of  Maryland,  whence  he  graduated 
with  the  class  of  1880.  Since  graduation  his  time 
has  been  devoted  to  the  general  practice  id'  medi- 
cine. He  is  medical  examiner  for  The  Shield  of 
Honor  Life  Insurance  and  is  a  member  of  the 
Flint  Cluh.  He  is  a  .Mason.  He  married  Annie 
R.  Mereier,  by  whom  he  has  a  daughter,  Mareese 
Wilson. 


ITEMS. 
Doctor  Lot  Ridgely  Wilson,  class  of  1880,  is  a 
native  id'  Baltimore,  in  which  city  he  ha-  engaged 
in  the  practice  of  medicine  for  more  than  twenty- 
five  years.      He  was  horn  June  9,  1858,  and  is  the 


Doctor  Horace  Melville  Simmons,  class  of  1881, 
of  Baltimore,  was  born  in  West  Bedford,  Coshoc- 
ton county.  Ohio,  June  30,  1854.  He  was  the 
thinl  son  in  a  family  of  six  children.  His  father 
a  physician,  emigrated  from  Maryland  in  early 
boyhood,  and  at  the  age  of  twenty-seven  entered 
upon  the  practice  id'  medicine  in  Ohio. 

Doctor  Horace  Simmons  received  his  early  edu- 
cation in  Deersville,  Harrison  county.  Ohio.  Later 
he  entered  the  office  of  the  "Cadiz  Republican." 
After  three  years  of  practical  experience  in  editing 
ami  publishing,  he  accepted  an  engagement  with 
the  ••Coshocton  Democrat."  He  matriculated  in 
the  Medical  Department  of  the  University  of  Mary- 
land in  1879,  and  received  the  degree  of  Doctor  of 
Medicine  in  1881.  After  graduating  he  returned 
to  Ohio  to  enter  into  copartnership  with  his  father. 
in  which  connection  he  continued  until  1882,  when 
he  returned  to  Baltimore  to  enter  practice.  In 
1883  he  married  Miss  Y.  Estelle  Dunning, 
daughter  of  the  late  Reverend  Halsey  Dunning,  a 
Presbyterian  clergyman  of  Baltimore.  One  son 
survives  this  marriage,  Halsey  Melville  Simmons. 
M  is.  Simmons  died  in  1  895. 

Doctor  Simmons  was  again  married  in  1903  to 
Miss  Caroline  Frazier  Johnson,  of  Baltimore,  and 
lesides  at  1706  Park  avenue,  Baltimore. 

In  1893  he  organized  the  Health  Magazine  Com- 
pany, of  Baltimore  ami  Washington,  to  publish 
the  •"Popular  Health  Magazine."  The  year  follow- 
ing this  company  acquired  the  ownership  of  the 
''Maryland  Medical  Journal,"  and  both  publica- 
tions continued  under  his  management  until  1898, 
when  the  ••Health  Magazine"  was  disposed  of  to 
a  New  York  company.  In  July.  1906,  Dr.  Sim- 
mons acquired  a  controlling  tnteresl  in  the  "Medi- 
cal Review  of  Reviews,"  int..  Yew  York  and  Lon- 
don. In  1909,  he  relinguished  the  management 
of  the  "Maryland  Medical  Journal"  to  Dr.  Nathan 
Winslow,  class  of  1901,  so  that  he  might  he  able 
to  devote  his  entire  energies  to  the  "Review." 


136 


THE   HOSPITAL  BULLETIN 


Doctor  John  S.  Fulton,  class  of  1881,  professor 
of  State  medicine  in  the  University  of  Maryland, 
was  born  in  1859,  at  Fremont,  Ohio.  Be  is  the 
oldest  son  of  Reverend  William  Fulton,  1).  1)..  of 
Glasgow,  Scotland,  and  his  wife,  Nancy  Organ,  of 
Cable,  Ohio.  He  came  to  Maryland  in  1863,  when 
his  father  became  rector  of  All  Hallows'  Parish, 
Snow  Hill.  He  removed  to  Salisbury,  Mil.,  in 
1869.  In  1872  he  entered  St.  John's  College,  An- 
napolis. JIil.,  graduating  in  1876,  then  entered  the 
office  of  Dr.  Stephen  P.  Dennis,  Salisbury,  as  a 
student  of  medicine  and  taught  in  the  public 
schools  for  two  years.  He  then  entered  the  medi- 
cal department  of  the  University  of  Maryland, 
wheic  he  was  graduated  in  1881.  From  1881  to 
1881  he  practiced  at  Lakeville,  Dorchester  county, 
Md.,  and  in  Salisbury,  1881  to  1895.  In  the  lat- 
ter year  he  moved  to  Baltimore  ami  became  chief 
of  clinics  in  internal  medicine  at  the  University 
Hospital  Dispensary  and  later  clinical  professor  of 
Medicine.  In  November,  1896,  lie  was  made  sec- 
retary of  the  State  Hoard  of  Health  of  Mary- 
land, and  in  1902  was  appointed  professor  of 
State  Medicine  in  the  University  of  Maryland. 
About  1906  he  resigned  the  secretaryship  to  the 
State  Board  of  Health  to  become  secretary  of  the 
International  Congress  on  Tuberculosis,  in  which 
position  lie  displayed  marked  executive  ability  and 
generalship.  Doctor  Fulton  married  in  1888, 
Nancy  Helen  White,  of  Salisbury,  Md. 


Dr.  John  Homer  Hoffman  was  born  in  Balti- 
more, Augusl  17,  1857.  He  is  a  son  of  Dr.  Dan- 
iel P.  and  Maria  Burot  Hilhert  Hoffman.  His 
literary  education  was  obtained  at  Loyola  College, 
Baltimore,  and  his  professional  in  the  medical  de- 
partment of  the  University  of  Maryland,  whence 
he  was  graduated  with  the  class  of  1881.  Since 
which  time  he  has  been  engaged  in  active  practice 
in  his  native  city.  Doctor  Hoffman  is  a  member 
of  the  Roman  Catholic  Church,  the  Crescent  Club 
and  at  one  time  was  a  member  of  the  Baltimore 
Clinical  Society.  In  September,  1SS:i.  he  married 
Miss  Susie  L.  Burke,  by  which  union  he  has  be- 
gotten four  children — May  I..  Reginald  K.,  Alma 
L.  and  Joseph  D.  Hoffman 


Doctor  Caleb  \.  Athey,  class  of  1894,  of  Bal- 
timore, was  married  to  Miss  Helen  Skipwith  Wil 
mer,  a  graduate  of  the  Johns  Hopkins  Training 
School  for  Nurses,  August  3,  1909. 


Doctor  Walter  Van  S.  Levy,  class  of  1904,  for- 
merly of  Baltimore,  but  now  of  Stonleigh  Court, 
Washington.  District  id'  Columbia,  has  applied  to 
the  Circuit  Court  Xo.  2  to  have  his  surname 
changed  to  Van  Swearingen,  a  family  name.  The 
petition  states  Dr.  Levy  is  a  Gentile;  is  he,  ami 
the  name  signifies  a  person  of  Jewish  extraction. 
An  oi  del'  signed  by  Judge  Heuisler  requires  cause 
to  he  shown  by  October  I.  1909,  why  the  petition 
should  not  he  granted. 


Doctor    Edward   A.   Wareham,   id'   Hagerstown, 

.Md..  made  a  short  address  upon  "Clip,"  at  the 
Seventh  Annual  Convention  of  the  Cumberland 
Valley  .Medical  Association.  Doctor  J.  Walker 
Humrichouse,  class  of  1873,  was  one  of  the  com- 
mittee on  arrangements.  Doctor  Michael  J.  Me- 
Kinnon.  a  venerable  physician,  of  York,  Pa..  i< 
se; iously  ill  at  his  home. 


Doctor  Alberto  L.  Bartlett  lias  the  honor  of 
announcing  that  he  has  been  nominated  the  local 
head  id'  the  National  Sanitary  Board.  Doctor 
Bartlett  is  located  at  Placetas,  Cuba. 


Doctor  and   Mrs.  T.   B.  Maiden  are  making  an 
extensive  trip  through  the  AYest. 


Doctor  Siimmerlield  B.  Bond  was  recently  elect- 
ed vice-president  of  the  Baltimore  and  Ohio  As- 
sociation of  Railway  Surgeons. 


Doctor  Somerset   R.   Waters,  of  Ml.  Airy.  Md.. 
is   a   candidate    for   the   House   of    Delegates    Erom 

Carroll  county  upon  the  Democratic  ticket. 


Dr.  Joshua  W.  Hering.  who  was  re-nominated 
for  Comptroller  of  the  State  Treasury,  was  proba- 
bly the  oldest  man  of  prominence  at  the  recent 
Maryland  State  Democratic  convention.  He  was 
born  in  Frederick  county  76  years  ago.  Great  as 
has  been  the  demand  upon  his  time  as  a  physician, 
regardless  of  the  hour  of  day  or  night,  he  has 
found  time  to  take  active  part  in  religion,  educa- 
tion, finance  and  politics.  In  every  field  he  has 
gained   distinction   and   honors. 

After  si  inlying  in  the  public  schools  of  his  native 
county,  he.  as  a  boy.  started  to  work  in  a  store,  but 
decided  that  he  would  rather  be  a  physician,  lie 
began  the  study  of  medicine  under  the  private 
tutorship  of  Dr.  William  A.  Mathias.  at  that  time 
a  vjrominent  practitioner  in  Westminster.     He  then 


THE   HOSPITAL  BULLETIN 


137 


came  to  Baltimore  and  took  the  course  at  the  Mary- 
land University,  getting  his  degree  in  medicine  in 
1855.  Returning  to  Westminster  he  soon  built  up 
a  lucrative  practice  and  prospered  in  the  business 
enteiprises  in  which  he  became  interested.  In  1861! 
he  was  chosen  cashier  of  the  Union  National  Bank 
of  Westminster.  IIi~  prominence  among  the  bank- 
ers of  the  Slate,  aside  from  his  other  interests,  was 
such  that  in  1899  he  was  elected  president  of  the 
Maryland  Bankers'  Association. 

A  devout  churchman,  he  was  given  one  honor 
after  another  by  the  Maryland  and  general  con- 
ferences of  the  Methodist  Protestant  Church.  In 
1892  he  was  elected  president  of  the  General  Con- 
ference, the  only  layman  who  ever  held  that  posi- 
tion. Dr.  Bering  has  always  been  intensely  in- 
terested in  the  welfare  of  Western  Maryland  Col- 
lege, at  Westminster,  which  is  connected  with  his 
church.  He  is  the  president  of  the  board  of  trus- 
tees and  the  only  living  charter  member  of  thai 
board.  He  was  given  the  degree  of  master  of  arts 
by  Western  Maryland  College  in  1885  and  the 
degree  of  doctor  of  laws  by  St.  John's  College  in 
1900. 

Although  always  a  stanch  Democrat  and  one  of 
the  most  popular  men  in  the  party  in  the  State,  it 
was  not  until  1896  that  he  accepted  office.  In  that 
year  he  was  elected  to  the  State  Senate.  He  was 
first  elected  Comptroller  of  the  State  Treasury  in 
1899.  In  1901  he  was  re-elected,  but  declined  the 
nomination,  lie  was  re-elected  in  1907,  and  now 
he  has  been  re-nominated  to  serve  a  fourth  term 
in  that  office. 


Hi-.  William  .1.  Todd  read  an  interesting  paper 
at  the  recent  meeting  of  the  Baltimore  County 
Medical  Association,  held  at  Towson,  on  the  life 
of  the  late  Dr.  Josiah  S.  Bowen,  the  pioneer  physi- 
cian id'  Mount  Washington,  who  did  much  toward 
the  development  of  that  place.  Dr.  Bowen  was 
horn  on  March  1.  is:!'.',  on  the  Hillen  road.  In 
early  life  he  was  a  general  contractor,  and  in  1854 
he  went  to  California  and  shared  the  hardships 
and  adventures  of  the  "old  seekers  there. 

In  1860  Dr.  Bowen  returned  to  Maryland.  In 
1865  he  graduated  at  the  medical  department  of 
the  University  of  Maryland.  The  same  year  he 
located  at  Mount  Washington,  and  became  one  of 
its  leading  citizens.     In  conclusion  Dr.  Todd  said: 

"It  can  he  said  of  Dr.  Bowen  that  his  life  was 
quiet,  industrious  and  unassuming,  and  that  it  was 
a  success,  because  in  his  long  ami  active  practice  he 


relieved  the  sufferings  of  the  sick  and  added  com- 
I'oit  to  the  poor  and  the  aTicted.  I  recall  the 
-luck  to  me  and  the  community  of  his  sudden 
death,  being  found  dead  in  his  chair  on  the  morn- 
ing of  August  ""»,  1900,  after  arranging  for  the 
business  of  the  day — actually  dying  in  the  har- 
ness." 

Dr.  Josiah  S.  Bowen.  class  of  1903,  of  Mount 
Washington,  is  a  son  id'  Dr.   Bowen. 

Dr.  Benjamin  F.  Bussey,  class  of  1885,  president 
of  the  Association,  presided  at  the  meeting. 


Doctor  James  A.  Shackelford,  class  of  1876,  of 
Greenville,  Mississippi,  died  at  the  home  of  his 
nephew  in  Carrollton,  Mississippi,  duly  in,  1909. 


Reverend  Edward  Mortimer  Hardcastle,  class  id' 
1889,  of  the  University  of  Maryland,  died  at  his 
home  in  Kaston,  August  15,  1909,  of  consump- 
tion, aged  42. 


Doctor  Byron  Clark,  class  of  1881,  formerly 
professor  of  theory  and  practice  of  medicine  in 
the  Eclectic  Medical  College  of  the  City  of  New 
York,  died  at  his  home  in  Washington,  Pennsyl- 
vania, August  5,  1909,  from  diabetes,  aged  72. 

Doctor  Marshall  B.  West,  clas^  of  1901,  has 
bought  of  Elias  Livezy  a  residence  and  two-acre 
lol  mi  the  east  side  of  lngleside  avenue.  Catons- 
ville. 

Doctor  d.  Frank  Crouch  has  purchased  from 
Pierre  C.  Dugan  and  Nephew,  real  estate  brokers, 
representing  Thomas  O'Neill,  a  parcel  of  seven- 
teen acres  from  the  large  tract  of  land  recently 
purchased  by  Mr.  O'Xeill  on  the  Severn  river.  The 
land  is  beautifully  situated  at  the  junction  of  Cold 
Spring  Creek  and  the  Severn  river  and  is  known 
as  Long  Point.  It  is  the  intention  of  Dr.  Crouch 
to  improve  the  land  and  erect  a  beautiful  sum- 
mer residence,  for  which  he  is  having  plans  pre- 
pared. 


Doctor  Taylor  E.  Darby,  class  of  1904,of  Barnes- 
Mile.  Maryland,  was  one  of  the  successful  candi- 
dates before  the  last  examination  of  the  Army 
.Medical  Examining  Board,  for  a  commission  of 
second  lieutenant  in  the  Medical  Corps  of  the 
United  States  Army.  He  will  be  stationed  at 
the  Army  Medical  School,  Washington,  for  a  year 
when  he  will  take  the  examination  for  a  first 
lieutenancy. 


138 


THE  HOSPITAL  BULLETIN 


"Dr.  Arthur  E.  Ewens,  who  was  elected  Su- 
preme Medical  Director  at  the  recent  session  of 
The  Supreme  Ruling,  is.  in  the  language  of 
Brother  H  K.  Eaton,  who  nominated  him  for 
this  important  office,  'of  sterling  qualities  and 
unimpeachable  integrity,  occupying  a  pre-eminent 
position  both  as  a  man  and  as  a  physician.' 

■'The  history  of  the  University  of  Maryland, 
Vol.  3,  p.  477,  gives  much  interesting  information 
in  regard  to  his  achievements  and  his  high  stand- 
ing in  his  profession.  He  is  a  graduate  of  the 
State  College  of  Maryland  (his  native  State). 
at  which  College  lie  received  the  degree  of  Bach- 
elor of  Science  and  was  awarded  the  gold  medal 
for  the  best  graduation  thesis.  Upon  the  com- 
pletion of  his  college  course  he  entered  the  Medcial 
Department  of  the  University  of  Maryland,  from 
which  institution  lie  graduated  with  honor  in  a 
class  of  150,  receiving  the  degree  of  Doctor  of 
Medicine.  Immediately  following  his  graduation 
he  took  a  competitive  examination  for  appoint- 
ment as  resident  physician  and  surgeon  to  the  At- 
lantic City  (X.  J.)  Hospital,  receiving  first  place 
and  serving  in  the  above  position  for  one  year. 
He  enjoys  the  distinction  of  having  received  one 
of  the  highest  averages  ever  made  before  the  New 
Jersey  State  Board  of  Medical  Examiners,  winch 
is  universally  recognized  as  maintaining  a  very 
high  standard.  At  the  time  he  took  this  exam- 
ination 72  physicians  came  before  the  Board  for 
examination,  and  the  Doctor  was  one  of  only  two 
physicians  who  attained  an  average  of  over  90  per 
cent.  In  recognition  of  this  remarkable  record, 
his  name  was  sent  to  the  Governor  of  New  Jersey 
in  receive  honorable  mention. 

"At  the  expiration  of  his  first  four  years  in  the 
practice  of  medicine  he  was  chosen  out  of  150 
Atlantic  City  physicians  for  the  high  and  respon- 
sible position  of  Surgeon  to  the  Atlantic  City  Hos- 
pital, his  election  being  unanimous.  For  some 
time  he  held  the  position  of  Medical  Inspector  of 
Public  Schools  in  Atlantic  City.  He  is  also  Vis- 
iting Physician  and  Surgeon  to  the  Foster  Home 
for  Orphans  at  Longport,  X.  J. 

"Dr.  Ewens  is  a  member  of  the  following  Med- 
ical Societies:  The  Atlantic  County  Medical  So- 
ciety; Medical  Society  of  the  State  of  New  Jer- 
sey; American  Medical  Association;  Atlantic  City 
Academy  of  Medicine,  and  the  American  Academy 
of  Medicine  and  Medical  Club  of  Philadelphia. 

"That  he  is  a  true  Fraternalist  is  conclusively 
indicated  from  the  fact   that   he   is   a  member  of 


the  Fraternal  Mystic  Circle:  Ancient  Order  of 
United  Workmen;  Modern  Woodmen  of  America: 
Brotherhood  of  the  Union;  Patriotic  Order  of  the 
Sons  of  America  :  Bata  Mu  Chapter  of  Phi  Gamma 
Delta  Fraternity  at  the  Johns  Hopkins  Univer- 
sity (where  the  Doctor  took  a  post-graduate 
course),  ami  he  is  also  a  member  of  Belcher  Lodge. 
Xo.  180,  of  Free  and  Accepted  Masons,  Atlantic 
City,  X.  J. 

"As  Worthy  Medical  Examiner  for  the  Fra- 
ternal Mystic  Circle  his  is  a  most  remarkable  rec- 
ord. While  he  has  examined  between  300  ami  400 
applicants  during  the  past  three  years,  so  carefully, 
skillfully  and  conscientiously  has  his  work  been 
conducted  that  up  to  the  present  time  there  has 
not  been  a  single  death.  He  is  a  member  of  Pro- 
gressive Ruling,  Xo.  890,  at  Atlantic  City.  X.  J., 
in  connection  with  which  Ruling  this  splendid  rec- 
ord was  achieved. 

"Dr.  Ewens  has  entered  actively  and  earnestly 
upon  the  duties  of  his  office,  and  it  can  safely  he 
predicted  that  he  will  achieve  the  same  satisfac- 
tory results  in  this  responsible  position  which  he 
has  in  every  other  one  he  has  ever  occupied." 


The  State  Board  of  Medical  Examiners  of  North 

Carolina,  which  met  at  Asheville  June  9,  1909, 
announce  that  Doctor  Branch  Craig,  class  of  1909, 
of  Salishuiy.  North  Carolina,  attained  the  highest 
grade.  95  6-7  per  cent.  Those  of  our  school  ap- 
pearing before  the  Board  successfully  are: 
1  loctors — 

Robert   W.   Crawford,  class  of   1906,  of   Rocky 
Mount. 

G.  D.  Moose,  class  of  1907,  of  Wilson. 

1).  C.  Absher,  class  of  1909,  of  ohids. 

Asa  Thurston,  class  of  1909,  of  Taylorsville. 

James  L.  Moorefield,  class  of  1909,  of  Guilford 
College. 

Robert  S.  McElwee,  class  of  1909,  of  Statesville. 

C.  L.  Swindell,  class  of  1909,  of  Kinston. 

Edgar  M.  Long,  class  of  1909,  of  Hamilton. 

J.  F.  Dowdy,  class  of  1909,  of  Winston-Salem. 

J.  D.  Weatherly.  class  of  1909,  of  Kernersville. 

Fred.  Wharton  Rankin,  class  of  1909.  of  Moore- 
ville. 

Branch  Craig.  cla>s  of  1909,  of  Salisbury. 


We  are  pleased  to  announce  that  all  candidates 
from  University  id'  Maryland  of  the  class  id'  1909 

appearing  before  the  North  Carolina  State  Board 
of  Medical  Examiners  did  the  school  the  honor  of 


TIIK   HOSPITAL  BULLETIN 


139 


receiving  their  licensure.  Indeed,  out  of  thirteen 
appearing  before  the  Board  only  one  of  class  of 
l!in  |    failed  to  receive  his  license. 


Doctor  John  S.  McKee,  class  of  1907,  of  Ra- 
leigh, North  Carolina,  is  taking  the  Post-Grad- 
uate Course  a1  the  University  of  Maryland, 


Doctor  Thomas  Eben  Peeks,  class  of  1901,  of 
New  Britain,  Connecticut,  who  recently  had  a 
gastro-enterostomy  made  on  him  by  the  Mayo 
Brothers,  has  been  spending  a  few  days  in  Balti- 
more. He  is  looking  hale  and  hearty  and  does 
nol  look  the  invalid. 


I  inetov  Henry  McKee  Tucker,  class  of  1899,  of 
Raleigh,  North  Carolina,  stopped  off  recently  on 
his  way  to  New  York,  to  take  a  Post-Graduate 
course.  He  reports  that  he  has  succeeded  in  build- 
ing up  a  nice  practice.  This  will  he  good  news 
to  Dr.  Tucker's  numerous  friends. 


Doctor  James  Lee  .Hopkins,  class  of  1897,  of 
Havre  de  Grace,  Maryland,  paid  a  hurried  visit 
to  the  University  Hospital  recently.  He  is  look- 
ing hale  and  hearty. 


Doctor  Walter  Van  S.  Levy,  class  of  1904,  of 
Baltimore,  has  been  appointed  visiting  patholo- 
gists to  Freedman's  Hospital,  Washington,  as  a 
result  of  a  competitive  Civil  Service  examination. 
It  is  reported  that  he  was  the  only  eligible  out  of 
lil'tv  candidates. 


Doctor  C.  E.  Kriete,  of  Aberdeen.  Maryland, 
has  been  appointed  an  official  of  I  lie  Harford 
( lounty  Marathon. 


Doctor  James  M.  Craighill,  Clinical   Professor 
of  Medicine,  has  returned  from  Canada. 


Doctor  William  E.  Martin,  a  prominent  mem- 
ber of  the  class  of  1909,  of  Harrisonville,  Md,. 
has  issued  an  announcement  that  he  was  married 
to  Miss  Hannah  Bailey,  of  Easton,  Md.,  Sep- 
tember 25,  1907.  Dr.  Martin,  who  is  the  son 
of  Mr.  and  Mrs.  William  Martin,  of  Sykesville, 
Md.,  met  Miss  Bailey  in  1904,  while  she  was  study- 
ing to  lie  a  trained  nurse  in  the  Springfield   Hos- 


pital. They  were  married  at  Chambersburg  by 
the  Reverend  Doctor  Glenn,  pastor  of  the  Meth- 
odist Episcopal  Church  there.  Doctor  and  Mis. 
Martin  will  make  their  home  at  Harrisonville, 
where  the  Doctor  will  engage  in  the  practice  of 
his  profession. 


DEATHS. 
Doctor  James  Bordley,  class  of  18(>8,  one  of 
Queen  Anne's  county's  most  prominent  physicians, 
died  at  his  home,  in  Centreville,  on  the  afternoon 
of  August  30,  1909,  after  a.  lingering  illness. 
Doctor  Bordley  was  horn  in  Centreville,  March  14, 
1846,  and  was  taken  by  his  parents  in  181!i  to 
Baltimore,  where  he  remained  until  1861.  He  then 
entered  St.  John's  College,  now  the  department  of 
Aits  and  Sciences  of  the  University  of  Maryland, 
Lint  when  the  war  began  he  commenced  the  slud\ 
of  medicine  at  the  University  of  Maryland.  After 
his  graduation  in  1868  he  opened  an  office  in 
Centreville,  where  he  has  since  successfully  en- 
gaged in  practice.  He  was  elected  the  second  presi- 
dent of  the  Maryland  State  Board  of  Medical  Ex- 
aminers, serving  from  1893  until  his  resignation 
in  1896.  He  was  at  one  time  president  of  the 
Queen  Anne's  County  Medical  Society.  For  years 
he  was  a  director  of  Centreville  National  Bank. 
At  the  time  of  his  death  he  was  president  of  the 
Building  and  Loan  Association  of  Queen  Anne's 
County. 

In  18(18  Doctor  Bordley  married  Miss  Henrietta 
M.  C'hamberlainc,  of  Cecil  county,  who  died  within 
a  year.  In  1871  he  married  as  his  second  wife, 
Miss  Ella  F.  Brown.  By  this  union  was  begotten 
three  children — Madison  Brown,  who  is  a  grad- 
uate of  the  University  of  Maryland  and  now  clerk 
to  the  County  Commissioners  for  Queen  Anne's 
county;  Doctor  James  Bordley,  Jr.,  who  is  a  grad- 
uate of  the  Medical  Department  of  the  University 
of  Maryland,  class  of  1896,  and  an  ex-resident  of 
May  View  Asylum,  and  Meicello  Worthington,  who 
is  a  graduate  of  SI.  John's  College. 

In  connection  with  his  professional  and  other 
duties.  Doctor  Bordley  superintended  the  operation 
of  his  farms  in  Queen  Anne's  county.  He  was 
counted  one  of  the  most  successful  and  energetic 
business  men  as  well  as  one  of  the  leading  physi- 
cians of  the  Eastern  Shore  of  Maryland.  He  was 
a  prominent  member  of  many  societies  and  was 
their  medical  examiner.  In  politics  he  was  a  stanch 
Democrat. 


HUMAN    HANDS 

HAVE    NO    PART   IN    MANUFACTURING 


{Inflammation 's  Antidote) 

3UROM  the  moment  the  ingredients  are  placed  in  the  specially  designed  compounding 
Jlf  machine  until  the  nurse  removes  the  finished  product  from  the  sterilized  container 

at  the  bedside,  every  move  in  the  making  is  done  by  machinery  and  under  the  most 
rigid  antiseptic  precautions.  By  preventing  exposure  it  is  possible  to  conserve  to  the  highest 
possible  degree  Antiphlogistine's  hygroscopic  properties. 

No  plastic  dressing  can  be  mixed  in  a  mortar  box  with  a  hoe  or  in  an  ice  cream  freezer 
or  even  with  a  druggist's  mortar  and  pestle  and  possess  any  scientific  value.  Its  hygroscopic 
and  osmotic  qualities  are  necessarily  ruined,  owing  to  absorption  of  atmospheric   moisture. 

The    Denver   Chemical    Mfg.    Co. 

NEW  YORK 


ERTAIN  as  it  is  that  a  single  acting  cause  can  bring 
about  any  one  of  the  several  anomalies  of  menstrua- 
tion, just  so  certain  is  it  that  a  single  remedial  agent 
—  if  properly  administered — can  effect  the  relief  of 
any  one  of  those  anomalies. 

*J  The  singular  efficacy  of  Ergoapiol  (Smith)  in  the 
various  menstrual  irregularities  is  manifestly  due  to  its  prompt 
and  direct  analgesic,  antispasmodic  and  tonic  action  upon  the 
entire  female  reproductive  system. 

<J  Ergoapiol  (Smith)  is  of  special,  indeed  extraordinary,  value  in 
such  menstrual  irregularities  as  amenorrhea,  dysmenorrhea, 
menorrhagia  and  metrorrhagia. 

^  The  creators  of  the  preparation,  the  Martin  H.  Smith 
Company,  of  New  York,  will  send  samples  and  exhaustive 
literature,  post  paid,  to  any  member  of  the  medical  profession. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 
PRICE    ftl.OO    PER    YEAR 


Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter 


Vol.   V 


BALTIMORE,  MD.,  OCTOBER  15,   1909. 


No.   8 


A  SERMON  TO  STUDENTS  AT  THE  BE 
GINNING  OF  THE  SCHOOL  YEAR. 


By  Rev.  Jesse  Hill, 


Pastor  of  the  IVilliston  Congregational  Church. 
Portland,  Maine. 

Learn   to  do  well. — Isaiah   1:17. 

The  Biblical  writers  are  always  in  their  glory 
when  they  are  delineating-  the  growth  of  human 
character.  The  different  stages  of  character  un- 
folding was  one  of  their  chief  delights,  and  they 
are  never  more  charming  than  when  picturing  the 
progress  of  a  man  from  his  lesser  to  his  greater 
self.  They  were  lovers  of  a  well-balanced  man- 
hood. In  all  their  figures  of  speech  and  descrip- 
tions they  represent  life  as  a  great  effort.  Life 
is  a  struggle.  The  discipline,  the  toil  and  drudgery 
are  represented  as  having  a  very  beneficent  in- 
fluence in  the  development  of  character.  Dr. 
Drummond  declares  that  the  great  allies  of  prog- 
ress are  want  and  hunger ;  that  the  inertia  of 
things  is  such  that  without  compulsion  they  will 
never  move.  He  compares  the  evolution  of  a  man 
to  the  experience  of  a  little  bird  in  a  city  park, 
whose  day  is  spent  in  getting  a  living.  It  awak- 
ens at  daybreak  and  sets  out  to  get  its  breakfast, 
but  another  bird  has  been  awake  before  it,  and  it 
has  lost  its  chance.  With  30  other  breakfastless 
birds  he  must  bide  his  time,  scour  the  country, 
prospect  the  streets,  the  grass,  the  ground.  At 
every  meal  the  same  program  is  gone  through,  and 
every  day.  As  the  season  changes  the  drudgery 
becomes  more  keen.  Its  supplies  are  exhausted, 
and  it  is  compelled  to  take  its  wing  and  emigrate 
to  a  new  country.  This  is  how  birds  live,  and  this 
is  how  birds  are  made.  Life  is  a  fierce  effort,  a 
supreme  struggle — beek  and  limb,  claw  and  wing, 
shape,  strength — all  down  to  the  last  detail  are 
the  expressions  of  their  mode  of  life. 

Human  life  is  also  a  struggle,  excepting  that 
man  is  sometimes  lured  on  bv  visions  of  glorv  in- 


stead of  being  goaded  on  by  hunger.  There  is  a 
prevalent  conception  in  the  world  that  there  are 
some  favored  positions  and  vocations,  where  suc- 
cess is  attained  without  the  treadmill.  But  it  is 
probably  true  that  there  is  just  as  much  prosaic 
uninviting  detail  forced  into  the  lives  of  those  who 
are  supposed  to  be  living  the  charmed  life  as  there 
is  in  your  life. 

Not  manypeoplewho  stand  before  a  great  paint- 
ing and  admire  the  genius,  skill  and  brain  of  the 
artist  ever  appreciate  the  years  of  privation  and 
poverty  that  lay  back  of  the  artist's  success. 
Everything  valuable  is  costly.  The  dimensions  of 
our  soul  life  are  determined  by  the  ideal  to  which 
they  are  set.  The  quantity  and  quality  of  person- 
ality depend  upon  the  scale  after  which  we  copy. 
If  the  ideal  be  complete,  the  life  will  be  rich  and 
full,  and  if  the  dominating  aim  of  our  life  be  un- 
steady, without  a  clear-cut  purpose  and  definite 
goal,  the  life  will  be  as  shapeless  as  a  jellyfish. 

The  growth  of  every  character  has  three  stages 
— past,  present  and  future.  The  past  is  the  field 
of  wisdom;  the  present  the  sphere  of  endeavor; 
the  future  the  home  of  hope. 

It  is  possible  to  live  in  the  past  and  speak  words 
of  wisdom,  but  to  miss  the  everlasting  joy  of 
transforming  present  realities  into  living  facts. 
It  is  possible  to  live  in  the  present  and  forget  the 
storage  of  wisdom  which  men  have  left  for  our 
encouragement.  And  the  life  whose  eyes  are  fas- 
tened only  on  the  future,  while  hands  hang  list- 
lessly at  one's  side,  may  stand  sometimes  upon  the 
transfiguration  mount,  but  he  has  left  the  animals 
at  the  base  of  the  mountain  in  whose  presence 
there  is  little  safety  of  those  for  whom  we  are  re- 
sponsible. No  man  can  be  content  with  the  past 
or  present.  We  are  continually  stringing  our 
harps  for  the  winds  of  tomorrow.  Today  is  the 
child  of  yesterday,  and  tomorrow  is  the  legacy  of 
today.  All  future  character  depends  upon  our 
use  of  the  present. 

Someone  asked,  "Where  was  Italy  three  cen- 
turies ago?"  and  the  answer  was.  "Under  the  cap 
of  Dante."     For,   in  the  dream  of  the  patriotic 


142 


THE    HOSPITAL    BULLETIN 


poet,  there  throbbed  the  picture  of  broken  and 
bleeding  Italy,  marching  forth  in  triumph  to  its 
present  progress — liberty  and  union. 

Protestantism  three  centuries  ago  was  under  the 
cowl  of  a  Wittenberg  monk,  but  his  brain  was  the 
soil  in  which  grew  the  seed  which  we  call  Zwingli, 
Melancthon,  Knox  and  Wesley. 

Where  was  education  three  centuries  ago  but  in 
the  brain  of  Comenius,  and  his  life  was  the  soil  in 
which  Rosseau,  Froebel  and  Pestalozzi  sprouted. 
And  the  education  of  tomorrow  is  all  about  us,  in 
the  lives  of  those  whom  too  often  we  fail  to  ap- 
preciate. 

Once  a  year,  just  after  the  great  throng  of 
young  people  have  heard  again  the  call  of  the  col- 
lege or  the  high  school,  and  before  they  cross  its 
threshold,  I  like  to  devote  one  service  to  the  con- 
sideration of  some  phases  which  may  be  sug- 
gestive to  them  in  the  new  field  of  effort  to  which 
they  are  called. 

There  are  four  words  around  which  there  gath- 
ers wisdow  for  those  who  have  ears  to  hear.  These 
words  are  cultivate,  accumulate,  habitate  and  ded- 
icate. 

The  first  of  these  words  is  CULTIVATE. 

We  are  the  offspring  of  cultivation.  Natural- 
ists have  often  pointed  out  to  us  the  fact  that 
while  man  is  a  ruler  among  the  animals,  he  is  also 
the  most  helpless  creature  at  birth,  and  requires 
the  greatest  cultivation  to  reach  anything  like 
maturity.  The  chick  begins  to  peck  as  soon  as  it 
leaves  the  shell ;  the  duckling  takes  to  water  at 
once ;  birds  fly  in  a  few  weeks  after  they  are 
hatched,  while  in  three  months  a  pup  can  execute 
untold  damage  on  his  mistress'  parlor  carpet,  but 
the  babe's  life  hangs  by  a  thread  for  many  davs, 
and  infinite  care  is  needed,  in  the  absence  of  fav- 
orable conditions  its  life  is  in  danger,  and  with 
favorable  conditions  many  months  must  pass  be- 
fore the  child  can  even  stumble  around.  The 
family,  the  church,  the  State  and  the  school  then 
begin  to  contribute  to  its  education. 

The  force  of  this  command  to  cultivate  our  life 
gains  very  much  emphasis  when  we  remember 
that  upon  the  use  of  our  present  there  is  an 
inevitableness  in  the  result.  When  Charles  Dick- 
ens first  published  the  "Old  Curiosity  Shop"  he 
was  flooded  with  letters  from  all  parts  of  England, 
from  people  who  had  read  the  story  in  install- 
ments in  the  magazines,  pleading  with  him  not 
to  take  the  life  of  Little  Nell.  But  be  yielded  to 
the  inevitable,  and  when  at  last  he  reached  the 


story  of  her  health,  all  night  he  walked  the  streets 
of  London,  sad  at  heart,  as  though  he  had  lost  a 
real  friend,  but  he  said  :  "I  had  to  do  it ;  the  pre- 
ceding events  demanded  it,"  and  upon  the  use  of 
your  present  opportunity  some  of  you  will  write 
a  silly  novel;  some  will  write  a  fearful  tragedy, 
and  some  a  psalm  full  of  sweetness  and  love  for 
all  mankind. 

The  Divine  command  to  every  individual  is  to 
cultivate  his  field.  We  are  to  make  the  most  of 
ourselves  and  the  place  that  God  has  given  us. 

History  has  given  us  few  better  ilustrations  of 
the  art  of  cultivation  than  the  story  of  Michel 
Angelo.  Old,  blind,  feeble,  feeling  his  way  into 
the  art  gallery,  and  with  uplifted  face,  putting  his 
fingers  and  hands  over  the  torso  of  Phidias,  the 
Cardinal  heard  him  say :  "Great  is  this  marble, 
greater  still  the  hand  that  carved  it,  greatest  of 
all  the  God  who  fashioned  the  sculptor ;  I  still 
learn,  I  still  learn." 

Think  of  the  man  who  is  willing  to  toil  in  the 
drudgery  of  painting  the  ceiling  of  the  Sistine 
Chapel  with  the  picture  of  his  "Last  Judgement" 
and  the  story  of  the  "Creation"  for  seven  years, 
until  the  muscles  and  cords  of  his  neck  had  be- 
come so  rigid  that  he  could  not  look  down  without 
bending  his  whole  body.  Think  of  the  man  who 
carried  his  bread  with  him  to  the  scaffold  and 
worked  while  he  ate,  so  that  he  might  not  lose  any 
time.  For  days  his  clothes  remained  on  his  body, 
and  his  eyes  refused  sleep.  By  the  side  of  his  bed 
he  kept  a  block  of  marble,  and  the  chisel  and  mallet 
lay  on  his  table,  and  the  call  of  a  new  idea  was 
never  disobeyed.  When  his  three  score  years  and 
ten  were  passed  he  still  said,  "I  still  learn,  I  still 
learn."  Such  a  man  could  not  help  but  immortal- 
ize himself  in  art. 

May  I  use  another  illustration?  You  have  heard 
of  the  life  of  Robert  Louis  Stevenson.  He  was 
counted  by  some  the  most  remarkable  English 
writer  of  his  generation,  but  the  work  of  his  pen 
was  the  smallest  part  of  his  life.  If  the  stories 
he  wrote  and  the  poems  with  which  he  enriched 
the  world  are  at  last  forgotten,  what  the  man  was 
will  live,  for  his  character  was  one  of  the  most  un- 
selfish and  lovable  in  human  being?.  At  20  years 
of  age  he  had  spent  most  of  his  time  trying  to 
tinker  up  his  physical  frame,  and  then  found  him- 
self a  nervous  wreck  ;  at  30  years  of  age,  just  able 
to  sit  up  in  bed  and  mould  clay  figures',  after 
which  he  rapped  his  fingers  upon  the  board  and 
called  for  his  writing:  materials,  and  rave  form 


THE    HOSPITAL    BULLETIN 


143 


to  those  remarkable  stories  that  were  the  delight 
of  our  earlier  life.  Fighting  his  poverty,  lowli- 
ness, ill-health,  he  rose  above  his  troubles,  and  to 
the  very  last  remained  the  child  of  laughter  and 
sunshine.  Men  said  of  him  that  he  was  always 
eager  to  help  his  fellows,  always  ready  to  take  the 
second  place.  With  great  difficulty  offended,  and 
expecting  to  die  for  20  years,  he  "dug  out  the  ker- 
nal  of  life  and  threw  away  the  husks."  Each 
morning  seemed  to  him  like  a  golden  gift  from 
God  of  which  he  must  make  the  most. 

It  ought  to  be  the  mission  of  your  life  to  culti- 
vate facts.  Concrete  facts  are  terribly  dynamic. 
Intelligent  knowledge  is  the  rudder  of  zeal.  With- 
out facts  men  sail  and  sail,  and  arrive  nowhere. 
A  multitude  of  people  have  accumulated  some- 
thing like  facts — forty-second  cousins  to  the  real 
thing,  but  so  often  have  failed  to  get  the  facts. 
See  to  it  that  you  recognize  the  tremendous  power 
of  facts  in  your  education,  but  remember  that 
facts,  after  all,  are  but  means  to  the  end.  The 
mission  of  the  teacher  and  the  school  is  to  enable 
people  to  think.  It  is  to  draw  inferences  from 
certain  facts,  it  is  to  arrive  at  certain  conclusions. 
Cultivate  not  only  the  power  of  fact  and  think- 
ing, but  also  the  power  of  expression.  So  often 
in  human  life  we  find  that  the  most  intelligent 
people  must  secure  men  to  carry  their  intelligence 
to  market.  Now,  the  marks  of  a  cultivated  life 
are  modesty,  humility,  delicacy  of  organization, 
and  executive  tact ;  just  the  things  that  are  usually 
crushed  in  the  struggle  for  life,  thus  the  real  forces 
of  life  are  often  obscured.  The  great  lawyer  is 
not  always  at  the  head  of  the  bar;  the  man  who 
speaks  twenty  languages  is  not  the  successful 
teacher:  Samuel  Johnson  was  not  skilled  enough 
in  literary  bargains  to  protect  his  self-interest: 
the  walking  encyclopaedia  is  usually  used  as  a  ref- 
erence library.  This  is  because  men  have  not  cul  - 
tivated  themselves  symmetrically.  See  to  it  that 
while  your  brains  are  cultivated  that  your  brawn 
is  not  forgotten.  When  you  decline  Latin,  see 
that  you  do  not  decline  exercise.  Let  the  culti- 
vation of  your  life  give  you  the  fullest  use  of  all 
your  powers.  It  has  been  too  long  supposed  that 
a  man  goes  to  school  so  that  they  may  pump  wis- 
dom enough  into  him  to  enable  him  to  ladle  out 
at  retail  all  the  remainder  of  his  davs.  provided  he 
does  not  ladle  too  fast.  Rut  the  most  important 
part  of  education  is  what  you  get  for  yourself. 
The  term  education  has  been  abused,  but  never- 
theless it  stands  fo*-  a  great  idea.     All  that  the 


school  can  do  for  you  will  be  but  a  small  matter 
compared  with  what  you  must  do  for  vourself. 

The  second  duty  in  the  struggle  of  life  is  to 
accumulate. 

I  exhort  you  to  amass  a  fortune  in  your  field  ; 
even  on  its  lowest  basis — that  of  money — it  is  the 
duty  of  a  man  to  make  his  expenditure  less  than 
his  income.  The  tendency  in  our  age  is  toward 
extravagance.  Debt  has  ruined  a  multitude  of  peo- 
ple. What  is  there  that  is  more  pathetic  than  that 
picture  in  the  life  of  old  Walter  Scott,  when  Lock- 
hart  wheeled  him  into  the  summer  house  and  saw 
that  he  was  killing  himself  by  the  work  which  he 
felt  he  must  do  because  of  his  debts.  One  day  he 
suddenly  said :  "This  will  never  do,  I  must  get 
down  to  work."  and  when  he  tried,  he  could  not 
hold  the  pen  or  dictate  a  word,  but  sat  still,  with 
the  tears  streaming  down  his  fine  old  face — a  vic- 
tim of  debt. 

Someone  has  said,  If  you  should  call  the  roll  of 
a  score  of  the  most  cultivated  children  of  this  gen- 
eration, you  would  find  that  eight  out  of  twenty,  in- 
cluding a  great  orator,  a  novelist,  two  jurors,  a 
wit  and  two  statesmen  were  all  caught  in  the 
meshes  of  debt.  These  sons  of  genius  fell  on 
death,  like  birds  caught  in  the  thicket  that  tore  off 
their  bright  plumage  in  the  struggle  to  escape  the 
thorns,  only  to  fall,  beating  their  bleeding  wing> 
against  the  ground.  There  is  a  happy  land  be- 
tween the  acrtic  zone  of  poverty  and  the  tropic 
zone  of  plenty  where  men  spend  less  than  they 
earn,  and  thus  accumulate.  But  remember  that 
money  is  not  the  only  wealth.  Anything  that 
makes  for  weal  is  wealth.  Mr.  Pearson,  who  has 
given  his  millions  for  colleges,  would  be  poor  if 
he  had  nothing  but  his  money.  Mr.  Peary,  in  the 
Arctic  regions,  with  bones  and  metals  would  be 
richer  than  the  Standard  Oil  magnate  with  his 
checkbook.  Money  is  easily  destroyed.  A  gold 
piece  will  wear  away.  The  banknote  will  disap- 
pear at  the  touch  of  a  match.  Every  man  can  ac- 
cumulate better  goods  than  these.  Knowledge  is 
one  of  the  things  that  does  not  perish.  Health  is 
a  blessing  that  has  no  value  in  money.  There 
is  a  certain  atmosphere — an  indefinable  quality — 
sometimes  called  culture,  that  comes  from  a  course 
in  college  that  is  invaluable  in  life.  Think  of  the 
people  that  never  accumulate.  They  had  a  single 
talent  given  them  at  the  beginning  and  they 
wrapped  it  in  a  napkin.  It  was  a  small  napkin. 
There  the  people  who  began  small  grow  smaller 
and  finally  evaporate.    They  are  like  one  of  the 


144 


THE    HOSPITAL    BULLETIN 


rivulets  that  we  meet  in  our  summer  travels,  trick- 
ling, like  a  slender  thread,  their  way  among  the 
barren  stones,  but  every  thirsty  noondav  sun 
makes  them  disappear.  They  trickle,  trickle, 
trickle  until  death  dries  them  up,  and  no  one 
misses  them.  They  were  a  blessing  to  no  one ; 
they  refreshed  no  living  thing.  Earth  is  not  any 
poorer  for  losing  them,  and  heaven  not  much 
richer  for  gaining  them.  How  much  different  is 
the  life  that  grows  richer  through  accumulation. 
Their  life  is  like  a  river.  It  has  its  birth  under 
some  mossy  rock  in  the  mountain.  It  steers  its 
modest  path  over  the  rough  roads,  laughing,  leap- 
ing with  its  own  silvery  music.  Sometimes  it  dis- 
appears for  a  while,  but  when  you  find  it  again 
it  is  like  a  broad  river,  beating  against  its  banks, 
swelling  up  and  kissing  the  boughs  that  bend  over 
it,  and  spreading  out  and  spreading  out  until  on 
its  placid  bosom  the  ships  laden  with  merchandise 
ride  at  anchor,  and  in  its  azure  depths  is  mirrored 
the  flags  of  every  nation.  Let  your  life  grow  rich 
in  the  volume  of  every  grace,  and  as  you  sail  the 
great  ocean  of  life  see  to  it  that  you  mirror  back 
the  glory  of  Christ's  gracious  handiwork,  as  you 
bear  up  human  hopes  and  contribute  your  share 
to  the  enrichment  of  the  world. 

The  third  step  in  the  struggle  of  life  is  to  have 
a  goal  of  Habitation.  Every  man  makes  his  own 
world.  We  may  make  out  of  the  materials  a 
mansion.  Multitudes  of  people  that  have  beautiful 
houses  live  in  baskets,  because  they  live  subordi- 
nate to  physicial  pleasures  and  public  wants.  With 
everything  about  them,  there  are  people  who  fail 
to  use  what  they  have  in  the  right  way. 

In  a  Western  city  a  church  was  about  to  erect 
a  building,  and  the  question  arose  as  to  what  ma- 
terial should  be  used.  Some  would  have  granite 
of  New  England  ;  others  wanted  the  green  rock 
of  Pennsylvania,  and  some  others  were  in  favor 
of  the  limestone  and  brick.  An  old  farmer  said : 
Let  us  build  our  church  out  of  the  very  bowlders 
which  lie  on  the  surface  of  the  prairies  all  about 
us.  The  novelty  of  the  suggestion  brought  every- 
body to  its  support.  The  church  was  built,  and 
then  it  was  discovered  that  from  these  homely 
stones  an  edifice  of  sumptuous  beauty  had  been 
reared.  In  them  were  all  the  glories  of  the  rain- 
bow, and  this  house,  constructed  at  little  cost  and 
from  material  unnoticed,  is  the  admiration  of  all 
who  see  it.  Though  each  be  unattractive  in  itself, 
yet   grouped   together   in   the   tones    of   precious 


stones,  the  materials  of  a  glorious  life  lie  all 
around  us. 

From  the  lumber  that  is  taken  from  the  same 
mill  one  man  constructs  a  hovel,  another  builds 
a  mansion.  The  only  difference  between  the  mor- 
tar and  bricks  that  are  used  in  the  warehouse  and 
the  mortar  and  bricks  that  are  used  in  a  palace 
is  the  dream  of  the  architect.  The  difficulties 
which  hinder  one  man  become  stepping-stones  to 
another  man.  Marsden  says,  "Some  people,  like 
the  bee,  seem  to  gather  honey  from  every  Mower ; 
while  others,  like  .the  spider,  carry  only  poison 
away."  One  person  finds  happiness  everywhere, 
and  on  every  occasion  carrying  his  own  holiday 
with  him ;  another  always  appears  to  be  returning 
from  a  funeral.  One  sees  beauty  and  harmony 
wherever  he  looks ;  his  very  tears  afford  him  vi- 
sions of  rainbows  as  the  sunbeams  of  hope  fall 
upon  them.  Another  is  blind  to  beauty ;  the  lens 
of  his  eyes  seem  to  be  smoked  glass,  draping  the 
whole  world  in  mourning.  One  sees  in  the  match- 
less rose  nothing  but  rose  water  for  sore  eyes ; 
another  reads  in  its  blending  colors  and  its  won- 
derful fragrance  the  "thoughts  of  God." 

One  student  finds  just  what  he  is  looking  for  in 
the  college  to  which  he  goes — the  best  teachers, 
the  finest  equipment,  the  most  glorious  history — 
and  he  becomes  an  enthusiastic  alumnus  at  the  end 
of  his  course ;  but  another  finds  in  every  college 
to  which  he  goes  that  the  equipment  is  limited,  the 
teachers  poor,  and  the  college  devoid  of  any  true 
spirit.  (  )ur  subjective  attitude  has  much  to  do 
in  what  the  school  will  mean  to  us. 

The  earth  beneath  our  feet  is  largely  composed 
of  four  substances :  Clay,  sand,  soot  and  water. 
Give  it  the  right  conditions,  and  the  clay  will  be- 
come porcelain  and  furnish  the  finest  kind  of  a 
background  for  a  fine  painting;  give  the  sand  the 
right  conditions,  and  it  will  become  hard  and 
white  and  will  take  into  itself  the  blue  rays  of  the 
sunlight  and  become  a  sapphire :  the  soot,  under 
proper  conditions,  is  transformed  into  a  diamond, 
and  the  water  in  the  summertime  is  a  dew  drop 
and  in  the  winter  a  star. 

The  humblest  and  lowliest  life  with  the  right 
spirit  may  build  a  mansion  with  a  window  that 
opens  out  on  to  the  radiant  clouds ;  a  mansion, 
with  a  door  to  the  street  that  swings  out,  that  the 
tenderness  and  sympathy  of  our  lives  may  flow  out 
to  a  saddened  world,  and  swing  in  with  a  hospital- 
ity that  may  be  found  for  the  stranger,  the  desti- 


THE    HOSPITAL    BULLETIN 


145 


tute  in  the  fireside  and  table  of  good  cheer  which 
we  give  to  the  world. 

And,  finally,  it  is  your  duty  toDedicate  your  life. 
In  the  18th  Chapter  of  Jeremiah  there  is  a  re- 
markable description  of  Jeremiah's  one  day  go- 
ing into  the  valley  where  the  potter  was  at  work 
moulding  clay  on  a  wheel.  And  as  he  stood  by 
and  watched  the  skillful  manipulation  of  the 
worker  he  had  no  idea  what  pattern  was  in  the 
designer's  mind,  though  probably  it  was  one  of  the 
noblest  conceptions  and  designed  for  some  royal 
or  special  purpose.  And  so  by  those  rapid  revo- 
lutions of  the  wheel,  the  ideal  began  to  take  shape. 
Suddenly  the  designer  took  the  clay  from  the 
wheel  with  an  exclamation  of  disappointment.  The 
design  was  spoiled.  Because  the  teacher  was 
wanting  in  skill  ?  Xo  ;  but  because  the  clay  refused 
to  take  on  the  shape  which  he  had  designed.  The 
work  was  therefore  marred  on  the  wheel,  and  he 
was  compelled  to  make  out  of  the  clay  some  in- 
ferior vessel  to  that  which  he  had  intended.  It 
might  have  served  a  noble  purpose  in  a  royal 
household,  or  even  in  the  temple  service,  but  it  was 
now  fashioned  into  some  coarser  form,  for  use 
in  a  business  house. 

The  parable  is  not  without  its  lesson,  and  so,  if 
we  dedicate  our  lives  to  Him  completely,  the  ideal 
will  reveal  itself  in  our  experience.  It  is  a  fatal 
mistake  to  put  off  the  matter  of  sharing  that  with 
which  we  are  intrusted  until  some  future  time. 
If  you  ever  expect  to  bless  the  world,  begin  now. 
Whatever  wisdom  you  have  is  a  trust  for  the  sake 
of  ignorance ;  all  wealth  is  a  trust  for  the  sake  of 
poverty.  You  are  simply  stewards  of  strength 
for  the  sake  of  those  who  are  weak ;  every  college 
boy  and  girl,  and,  indeed,  every  high-school  boy 
and  girl  is  a  privileged  life.  They  are  selected 
people  in  the  providence  of  God,  and  to  none  more 
than  these  should  there  come  a  great  conviction 
that  it  is  to  be  their  privilege  and  duty  to  build  the 
booths  in  the  desert  of  life  for  the  sake  of  the 
world-smitten  ones,  and  to  dig  the  springs  in  the 
oasis  for  the  sake  of  life's  thirsty  ones ;  to  bear 
the  burdens  of  those  whom  they  meet,  and  in  that 
very  dedication  they  shall  build  for  themselves  a 
palace  of  beauty  which  shall  be  filled  with  pros- 
perity and  God's  peace. 


Take  a  dish  of  water  cold, 
A  little  leaven  of  prayer, 

A  little  bit  of  morning  glow, 
Dissolved  in  the  morning  air. 


Add  to  your  meals  some  merriment. 

A  thought  of  kith  and  kin. 
And  for  your  prime  ingredient 

A  plenty  of  work  thrown  in. 

Then  spice  it  ail  with  an  essence  of  love, 

And  a  little  whiff  of  play; 
Let  the  wise  old  Book  and  a  glance  above 

Complete  the  well-made  day. 

Cultivate — Accumulate — Habitate  —  and  Dedi- 
cate your  life  in  the  struggle  for  existence. 


A  VISIT  TO  THE  MAYO  CLINIC  AT 
ROCHESTER,  MINN. 


By  Randolph  Winslow. 

The  city  of  Rochester  is  situated  in  Minnesota, 
350  miles  northwest  of  Chicago.  Its  population 
is  about  8000.  It  is  the  county-seat  of  Olmsted 
county,  Minnesota,  which  is  said  to  be  the  richest 
agricultural  county  in  the  United  States.  It  is 
quite  a  handsome  town,  with  attractive  residences 
and  large  stores.  Its  chief  importance,  however, 
is  due  to  the  fact  that  here  is  located  St.  Mary's 
Hospital,  at  which  the  Drs.  Mayo  do  their  sur- 
gical work.  St.  Mary's  Hospital  is  a  fine  institu- 
tion, capable  of  accommodating  225  patients.  The 
surgical  work  that  is  done  in  this  institution  by 
the  Drs.  Mayo  and  their  assistants  is  so  stu- 
pendous in  amount  and  excellent  in  skill  that  phy- 
sicians and  surgeons  from  all  over  the  United 
Stales  are  in  constant  attendance  upon  this  clinic, 
as  well  as  many  eminent  surgeons  from  Europe 
and  other  parts  of  the  world.  My  first  visit  to 
this  clinic  was  made  in  the  winter  of  1904,  upon 
which  visit  I  was  accompanied  by  Dr.  J.  Mason 
Hundley.  Our  reception  was  so  cordial,  and  the 
work  we  were  able  to  see  was  so  great  and  of  such 
variety,  that  I  have  desired  many  times  to  repeat 
the  visit.  The  opportunity,  however,  did  not  ap- 
pear to  present  itself  until  the  first  week  of  Sep- 
tember of  this  year.  Leaving  Baltimore  upon 
September  4  in  company  with  Dr.  Robert  P.  Bay, 
superintendent  of  the  University  Hospital,  we 
took  our  journey  toward  the  Northwest,  and 
reached  our  destination  30  hours  later.  We 
found  a  large  company  of  physicians  in  attend- 
ance on  the  clinic,  exceeding  50  daily  during  the 
time  of  our  stay.  As  has  been  said,  these  phy- 
sicians were,  many  of  them,  prominent  men  from 


14'' 


THE    HOSPITAL    BULLETIN' 


various  parts  of  the  United  States,  and  several 
were  surgeons  from  European  countries.  We 
were  received  with  great  cordiality,  and  every 
opportunity  was  afforded  us  both  to  see  the  opera- 
tions and  to  inspect  the  hospital.  From  20  to  30 
operations  are  performed  daily,  beginning  at  8 
o'clock  in  the  morning  and  ending-  usually  at  1 
or  half-past  1  in  the  afternoon.  These  operations 
arc  performed  usually  by  Drs.  William  J.  and 
Charles  11.  Mayo,  who,  with  Dr.  E.  S.  Judd,  are 
the  regular  operators  at  the  hospital;  but  many 
operations  are  also  performed  by  Drs.  Beckman 
and  Henderson,  who  are  members  of  the  surgical 
staff.  Dr.  William  J.  Mayo  confines  himself 
chiefly  to  work  upon  the  abdominal  organs,  and 
he  is  undoubtedly  the  greatest  abdominal  surgeon 
in  the  world.  Dr.  Charles  H.  Mayo  devotes  his 
attention  especially  to  general  surgery,  though  lie 
is  equally  at  home  in  any  of  the  other  lines  of 
surgical  work.  He  is  by  far  the  most  experienced. 
as  well  as  most  skillful,  operator  upon  goitre  in 
this  country,  and  his  work  on  this  line  of  cases  is 
truly  phenomenal,  lie  is  equally  at  home,  how- 
ever, in  operating  upon  the  eye  or  upon  the  ab- 
dominal viscera,  or,  in  fact,  in  almost  any  line  of 
surgical  work.  Dr.  Judd,  the  younger  member 
of  this  aggregation,  and  who  is  related  by  mar- 
riage to  the  Drs.  Mayo,  also  does  an  enormous 
work  of  a  great  variety.  When  some  of  these 
men  are  absent  the  work  is  taken  up  by  other 
members  of  the  stall.  Their  work  is  character- 
ized by  great  celerity  as  well  as  by  exceptional 
skill,  and  the  visitors  at  the  clinic  go  from  one 
room  to  another  in  quick  succession,  though  it  is 
absolutelv  impossible  for  one  person  to  see  all  the 
operations  that  are  clone.  I  was  especially  inter- 
ested in  the  goitre  work  by  Dr.  Charles  II.  Mayo, 
and  in  four  days  was  able  to  see  10  or  11  cases 
of  goitre  operated  on  of  both  the  simple  and  ex- 
ophthalmic varieties.  It  was  astonishing  to  note 
with  what  ease  and  safety  operations  upon  these 
difficult  cases  were  performed.  By  the  subcapsu- 
lar method  all  danger  of  injuring  the  parathyroid 
glands  and  the  laryngeal  nerves  was  avoided.  I  [is 
operations  for  cancer  of  the  breast  are  character- 
ized by  thoroughness  and  speed,  so  that  opera- 
tions which  in  the  hands  of  many  require  several 
hours  for  their  performance  are  usually  accom- 
plished by  him  in  about  30  minutes.  As  has  been 
said.  Dr.  William  J.  Mayo  confines  his  work 
chiefly  to  abdominal  surgery.  He  is  operating 
almost  daily  upon  the  stomach  and  intestines,  as 


well  as  upon  the  other  abdominal  organs.  W'e 
were  fortunate  in  being  able  to  see  performed 
many  serious  operations  upon  the  digestive  or- 
gans, as  well  as  upon  most  of  the  other  organs 
situated  within  the  abdominal  cavity.  During 
our  visit  he  performed  four  partial  gastrectomies, 
in  which  a  large  portion  of  the  stomach  wa-  re- 
moved for  cancer.  W'e  also  saw  several  gastro- 
enterostomies, several  resections  of  the  caecum 
and  sigmoid  colon,  and  were  permitted  to  see  the 
cases  subsequently  in  the  hospital,  and  found  all 
of  them  doing  entirely  satisfactorily.  We  saw 
three  nephrectomies  for  various  causes,  one  being 
for  hypernephroma,  which  is  ordinarily  regarded 
as  a  rare  form  of  kidney  tumor,  but  which  Dr. 
Mayo  says  is  the  most  frequent  malignant  neo- 
plasm of  these  organs.  A  number  of  gall-bladder 
operations  were  performed,  as  well  as  operations 
upon  the  urinary  bladder,  the  uterus,  ovaries  and 
lubes,  to  say  nothing  of  the  vast  lot  of  less  serious 
work  that  was  performed  daily.  The  work  at  this 
clinic  is  reduced  to  an  absolute  system-  The  vis- 
itors are  summoned  to  the  different  operating- 
rooms  by  the  ringing  of  an  electric  bell,  which 
indicates  by  the  number  of  strokes  the  room  in 
which  the  operation  is  about  to  be  begun,  and 
visitors  are  not  expected  to  enter  any  of  the  oper- 
ating-rooms until  the  proper  signal  has  been 
given;  but  as  operations  are  going  on  in  three 
rooms  at  the  same  time,  it  is  impossible  for  each 
person  to  view  all  of  the  work,  and  he  must  see 
that  which  is  most  instructive  to  him.  The  admin- 
istration of  the  anaesthetic  is  done  entirely  by 
women  nurses,  and  there  is  very  little  struggling 
or  evidence  of  difficulty  to  be  seen  during  the 
administration  in  comparison  with  most  clinics. 
The  assistants  are  few  in  number,  there  rarely 
being  more  than  two  in  addition  to  the  anaesthet- 
ist and  the  nurse.  The  operating-rooms  are  well 
equip] ied,  but  are  not  elaborate,  and  the  excel- 
lence of  the  results  attained  is  due  not  so  much  to 
the  superiority  of  the  equipment  as  to  the  skill 
of  the  operators  and  the  excellence  of  the  organi- 
zation. St.  Mary's  Hospital  is  conducted  by  an 
order  of  Catholic  Sisters,  and  was  started  just  20 
years  ago  as  a  small  institution  by  Dr.  William  W, 
Mayo,  the  father  of  the  Drs.  William  J.  and 
Charles  H.  Mayo,  who  is  still  living  and  hale  at 
the  age  of  01  years.  By  successive  additions  and 
alterations  the  hospital  now  is  practically  a  fire- 
proof structure  of  handsome  design,  with,  as  has 
been   said,  accommodations   for  225  patients.     It 


THE    HOSPITAL    PULLETIX 


147 


is  a  marvel  to  everyone  how  a  work  of  such  mo- 
ment can  be  done  in  a  hospital  of  no  greater  ca- 
pacity than  this.  Patients  are  gotten  out  with 
remarkable  quickness,  so  that  but  few  of  them 
remain  in  the  hospital  longer  than  two  weeks, 
even  after  a  most  serious  operation.  There  is, 
however,  a  constantly  increasing  list  of  patients 
waiting  to  be  operated  upon  when  accommoda- 
tions shall  be  found  for  them  in  the  hospital.  Fur 
example,  we  were  told  that  25  cases  of  goitre  were 
on  the  waiting  list  of  Dr.  Charles  H.  Mayo  and 
15  cases  of  cancer  of  the  breast  were  also  waiting 
an  opportunity  for  operation. 

The  Mayo  offices  are  not  at  St.  Mary's  Hos- 
pital, but  are  located  in  the  Masonic  Hall  in  the 
center  of  the  town,  and  here  a  great  throng  of 
patients  are  examined  and  treated  by  Drs.  ( na- 
ham  and  Plummer  and  others,  and  nine-tenths  of 
these  cases  are  not  surgical  and  do  not  come  un- 
der the  care  of  the  Drs.  Mayo  at  all.  At  half-past 
2  in  the  afternoon  the  Drs.  Mayo  go  to  their 
offices  and  examine  such  cases  as  are  referred  to 
them  to  determine  whether  they  shall  enter  the 
hospital  to  be  operated  on  or  not.  Most  of  these 
cases  are  ambulatory  in  character  and  do  not  re- 
quire immediate  attention,  and  they  are  obliged 
to  take  their  turn  for  admission  to  the  hospital. 
A  number  of  specialists  are  associated  with  the 
Drs.  Mayo  in  their  work  at  their  offices,  but  most 
of  the  patients  requiring  anaesthesia  are  operated 
on  by  the  regular  operators  at  the  hospital.  Prob- 
ably from  150  to  200  patients  daily  are  seen  by 
the  members  of  the  staff  at  the  offices.  Not  only 
is  the  medical  and  surgical  work  thoroughly  or- 
ganized, hut  the  pathological  department  is  also 
conducted  upon  the  same  broad  plans  as  the  other 
work  of  the  hospital.  Dr.  L.  B.  Wilson  is  the 
pathologist  in  charge  of  the  pathological  depart- 
ment, and  he  is  assisted  in  his  work  by  Dr.  \Y.  C. 
MacCarty  and  Dr.  Margaret  Smith.  One  or 
other  of  these  persons  is  always  within  reach  dur- 
ing the  operating  hours,  and  specimens  removed 
from  patients  are  at  once  submitted  to  an  exami- 
nation. If  there  is  doubt  as  to  the  nature  of  a 
tumor  or  growth,  a  frozen  section  is  made  and  a 
report  is  returned  within  five  minutes.  In  their 
museum  are  6000  appendices  which  have  been  re- 
moved within  the  last  four  years  ;  1200  goitres  are 
likewise  preserved,  as  well  as  specimens  of  all  the 
organs  and  structures  of  the  body.  The  Drs. 
Mavo  have  built  a  beautiful  library  and  assembly 


hall  for  the  use  of  themselves  and  associates,  and 
on  every  Wednesday  night  there  is  a  meeting  of 
the  members  of  the  staff  at  this  hall,  to  which, 
at  times,  visiting  physicians  are  likewise  invited. 
Here  reports  and  discussions  are  held  in  order 
that  the  latest  contributions  to  medical  literature 
may  be  communicated  to  all.  Whilst  many  phy- 
sicians visit  Rochester  for  the  purpose  of  attend- 
ing the  clinics,  when  the  clinics  are  over  there  is 
but  little  diversion  of  any  kind  to  be  enjoyed; 
consequently  a  surgeons'  club  has  been  formed, 
which  meets  daily  at  3  o'clock  in  the  afternoon  for 
the  purpose  of  discussing  and  further  explaining 
the  cases  that  have  been  under  observation  dur- 
ing the  day.  All  visiting  physicians  are  not  only 
eligible  for  membership  in  this  surgeons'  club,  but 
are  urged  to  join  it,  the  admission  fee  being  $2. 
In  this  manner  the  irksomeness  of  the  time  is,  in 
a  measure,  overcome.  At  the  east  end  of  Roch- 
ester is  a  large  and  well-conducted  Stale  Hospital 
for  the  Insane,  which  is  not  visited  by  many  phy- 
sicians, however.  The  chief  hotel  is  the  Cook 
House,  which  is  a  very  excellent  hostelry  at  a  very 
moderate  cost,  and  it  is  full  to  overflowing  all  the 
time.  In  addition  to  this,  there  has  recently  been 
erected  the  Kahler  House,  which  is  especially  in- 
tended for  convalescent  patients  and  their  friends, 
hut  to  which  visiting  physicians  are  admitted 
when  there  is  room  for  them.  This  is  a  smaller 
hotel  than  the  Cook  Plouse,  and  is  conducted  upon 
a  more  elaborate  scale,  and  naturally  is  much  more 
expensive.  The  Chute  is  also  a  hotel  or  sana- 
torium for  convalescent  patients  who  cannot  af- 
ford to  pay  the  charges  of  the  more  expensive 
hotels.  There  are  a  number  of  other  hotels  in  the 
town,  of  the  excellence  of  which  I  am  unable  to 
speak,  and  accommodations  can  also  be  had  in 
numerous  private  houses  for  those  who  prefer  a 
more  quiet  location.  Visiting  physicians  usually 
stay  about  a  week,  so  that  on  each  Monday  morn- 
ing a  practically  new  company  assembles,  and  on 
Saturday  there  is  a  general  hegira  from  the  town. 
Enough,  however,  remain  to  initiate  the  new- 
comers into  the  routine  of  the  clinic.  It  is  with 
great  pleasure  that  I  am  able  to  announce  offi- 
cially that  Dr.  Charles  H.  Mayo  will  deliver  two 
lectures  upon  the  surgery  of  the  thyroid  gland  at 
the  Lmiversity  of  Maryland  in  the  middle  of  No- 
vember, which  I  am  sure  will  be  interesting  and 
instructive  to  all  who  may  be  able  to  attend  them. 


148 


THE    HOSPITAL    BULLETIN 


SUBACUTE  INFLAMMATION  OF  THE 

ANTEROLATERAL  TRACTS  OF   ITIF. 

SPINAL   CORD   AS   AN    UNUSUAL 

COMPLICATION  OF  LA-GRIPPE. 


By  Joseph  W.  Hooper,  M.D., 


.  Issistant  Resident  Physician,  University  Hospital. 

Patient  white  ;  male  ;  age  39 ;  fanner  ;  single  ; 
entered  hospital  giving  the  following  history : 

One  year  and  a  half  ago  patient  had  a  severe 
attack  of  grippe,  with  its  usual  train  of  symptoms, 
high  temperature,  persistent  headache,  photopho- 
bia, general  pain  and  soreness  over  the  whole 
body,  etc.  He  refused  to  go  to  bed,  and  before 
he  had  entirely  recovered  from  his  attack  he  went 
out.  The  weather  at  that  time  was  cold  and  damp. 
Thinking  to  protect  himself,  he  wore  heavy  felt 
boots ;  he  noticed  in  a  short  time  that  these  were 
uncomfortably  hot ;  he  changed  them  for  a  pair 
of  light  shoes;  his  feet  and  legs  almost  imme- 
diately became  extremely  cold. 

Ten  days  after  this  he  noticed  that  his  legs 
seemed  heavy,  and  it  was  with  difficult}'  that  he 
was  able  to  raise  them  ;  this  was  more  marked  in 
left  lower  extremity  than  in  the  right.  There  was 
no  pain,  but  a  peculiar  drawing  sensation.  This 
condition  gradually  became  more  pronounced. 

Six  months  ago  the  patient  was  given  a  very 
hot  bath.  While  in  the  tub  the  drawing  became 
very  severe,  and  he  was  almost  unable  to  get  out 
of  the  tub  and  back  to  his  room. 

At  time  of  entrance  patient  complained  of  a 
burning  and  tingling  sensation  in  the  calves  and 
ankles,  numbness  in  his  feet  and  difficulty  in  rais- 
ing them  from  the  ground;  inability  to  walk  in 
the  dark,  and  a  tendency  to  trip  over  his  feet. 

He  also  complained  of  a  sense  of  constriction, 
about  two  inches  above  the  umbilicus.  This  was 
especially  noted  when  patient  bent  forward.  There 
was  a  constant  sense  of  fullness  in  the  stomach. 

He  tired  verv  easily  in  his  lower  extremities, 
especially  from  his  knees  down. 

At  times  patient  had  difficulty  in  voiding  his 
urine ;  at  other  time  he  was  unable  to  control  his 
urine,  and  frequently  soiled  himself.  The  same 
was  true  as  regards  the  evacuation  of  his  bowel. 

Three  days  prior  to  entrance  patient  jumped 
a  distance  of  10  feet ;  since  then  he  has  had  a  light 
feeling,  a  sense  of  constriction  over  his  sacrum. 
Appetite  good;  no  pulmonary  symptoms;  no  car- 
diac   symptoms;    no    urinary    or   gastrointestinal 


symptoms,  save  those  mentioned.  Nothing  of  im- 
portance obtained  from  past  or  family  history. 

Physical  examination  showed  a  verv  well-de- 
veloped white  man,  five  feet  10  and  one-half  inches 
tall,  bony  framework  (massive),  muscles  of  good 
tone,  skin  in  excellent  condition  ;  expression  good  ; 
mentality  and  memory  good ;  ears  low  set ;  teeth 
in  fair  condition  ;  palate  normal ;  heart  and  lungs 
normal. 

Upper  Extremities. — Motor  functions  nor- 
mal ;  sensory  functions  normal ;  coordination  nor- 
mal ;  no  atrophy. 

Rei  lexes. — Triceps,  biceps,  periosteal  and  ra- 
dial slightly  increased  on  both  sides. 

Trunk  and  lower  extremities  abdominal  muscles 
normal. 

Extensions  normal ;  flexions  of  thighs  and  legs 
weak ;  flexions  and  extensions  of  feet  normal. 

Sensory  Functions. — From  a  line  running 
around  the  body  on  a  level  with  the  umbilicus  in 
front  and  the  twelfth  dorsal  vertebra  behind,  to 
the  knees,  tactile  sensation  is  obtained ;  below  the 
knees  it  is  absolutely  lost. 

From  a  line  running  around  the  body  on  a  level 
with  the  anterior  superior  spines  of  the  ilium  to  a 
point  a  little  above  the  knees,  higher  in  back  than 
in  front,  sensation  of  pains  is  obtained,  patient 
being  unable  to  distinguish  sharp  from  dull  ;  be- 
low the  knees  it  is  absolutely  lost. 

From  a  line  running  around  the  body  on  a  level 
with  the  umbilicus  in  front  and  the  twelfth  dorsal 
vertebra  behind  to  a  line  five  inches  above  the 
knees,  temperature  sense  is  obtained  :  below  this 
line  it  is  lost. 

Where  sensation  can  be  preceived,  muscular 
sense  is  normal. 

Co-ordination  in  lower  extremities  poor;  Rone- 
berg's  sign  present ;  no  atrophies. 

Reflexes. — Abdominal  deficient;  tremasteric 
present,  but  delayed ;  patellar  reflexes  exagger- 
ated ;  Babinski  and  Cordon's  reflex  present  on 
Ik  ith  sides. 

Tendo  achilles  exaggerated  on  both  sides  ;  ten- 
dency  to  ankle  clonus ;  abnormal  movements.  At 
times  there  are  contractions  of  various  groups  of 
muscles  of  the  thigh  and  leg  on  either  side.  The 
contractures  occur  at  irregular  intervals,  some- 
times on  the  anterior  and  at  others  on  the  poste- 
rior surface.  Blood  and  urinary  findings  normal : 
tuberculine  reaction  negative  ;  spinal  puncture  and 
N-ray  examination  negative. 

From  the  history  and  examination  of  the  patient 


THE    HOSPITAL    BULLETIN' 


H') 


we  came  to  the  conclusion  that  we  were  dealing 
with  a  condition  that  was  either  directly  or  indi- 
rectly the  result  of  his  attack  of  la-grippe. 

The  conditions  that  suggested  themselves  were 
multiple  neuritis,  tabes  dorsales,  syringomyelia, 
inflammatory  changes  in  the  spinal  cord,  tuber- 
cular pachymeningitis  spinalis  and  syphilitic  men- 
nigo-myelitis. 

We  excluded  multiple  neuritis  by  the  presence 
of  increased  deep  reflexes,  bowel  and  bladder  dis- 
turbances ;  sensory  disturbances  on  the  trunk ;  sy- 
ringomyelia by  the  absence  of  dissociation  of  sen- 
sation ;  trophic  disturbances,  history  of  the  case, 
etc.  Tabes  dorsalis  was  excluded  by  the  history 
of  the  case,  absence  of  pulpillary  disturbances  and 
cranial  nerve  involvement,  presence  of  increased 
reflexes  and  distribution  of  the  sensory  distur- 
bances. 

Tubercular  pachymeningitis  was  excluded  by 
the  absence  of  the  tuberculin  reaction,  the  radiat- 
ing pains  and  negative  X-ray  plates.  Syphilitic 
meningomyelitis  was  excluded  by  the  absence  of 
any  history  of  syphilitic  infection  and  the  ab- 
sence of  improvement  on  thorough  antisyphilitic 
treatment. 

We  made  the  diagnosis  of  an  inflammatory  con- 
dition of  the  anteriolateral  portions  of  the  spinal 
cord  infections  in  character  for  the  following  rea- 
sons :  The  condition  occurred  immediately  fol- 
lowing or  in  the  course  of  an  existing  infectious 
disease,  "La-Grippe,"  the  gradual  progression  of 
the  disease,  the  character  and  distribution  of  the 
sensory  disturbances,  the  presence  of  bowel  and 
bladder  disturbances,  of  increased  deep  reflexes, 
of  the  typical  Babinski  and  Gordon  reflexes,  the 
distribution  and  type  of  motor  disturbances,  the 
absence  of  atrophies  and  trophic  disturbances  and 
the  irregular  spasmodic  contractures  of  various 
muscle  groups. 

The  following  treatment  was  recommended : 
Patient  was  freely  purged ;  kept  quiet  in  bed  for 
two  weeks  ;  counter  irritation  by  means  of  Spanish 
fly  blisters  applied  over  lower  dorsal  segments  of 
the  cord,  and  then  when  these  places  were  thor- 
oughly healed  a  light  plaster-of-Paris  jacket  was 
applied  to  the  patient  while  in  extension,  this  be- 
ing done  to  immobilize  the  back.  He  was  also 
given  internally  Fowler's  solution. 

Certain  changes  have  occurred  in  the  spinal 
cord  which  cannot  be  rectified,  but  we  can  at 
least  hope  for  some  improvement  and  to  stop  the 
further  progress  of  the  disease. 


THE  PROFESSORS  OF  SURGERY  IN  THE 
UNIVERSITY  OF  MARYLAND. 


By  Randolph  Winslow,  M.D., 

Professor  of  Surgery,  University  of  Maryland. 


No.  2. — William  Gibson,  M.D.,  LL.D. 

The  second  incumbent  of  the  chair  of  surgery 
was  Dr.  William  Gibson,  who  was  elected  to  this 
position  on  the  6th  of  April,  1812,  when  he  was 
but  24  years  of  age.  He  continued  to  hold  this 
chair  until  1819,  when  he  was  called  to  a  similar 
position  in  the  University  of  Pennsylvania.  Dr. 
William  Gibson  was  born  in  Baltimore  on  March 
14.  1788.  He  was  educated  at  St.  John's  and 
Princeton  colleges,  and  began  the  study  of  medi- 
cine at  the  University  of  Pennsylvania,  but  in 
1806  he  went  abroad  and  entered  the  University 
of  Edinburgh,  and  graduated  there  with  the  de- 
gree of  M.D.  in  1809.  Subsequently  he  went  to 
London  and  became  a  pupil  of  Sir  Charles  Bell, 
who  was  at  that  time  a  famous  surgeon  in  the 
English  metropolis.  Soon  thereafter  he  went  to 
the  seat  of  war  in  Spain  and  was  present  at  the 
battle  of  Corunna.  He  returned  to  Baltimore  in 
1810.  and  at  once  took  a  prominent  professional 
position  here.  In  1812  he  was  made  professor  of 
surgery  in  the  medical  school,  and  during  the 
summer  of  that  year  he  performed  the  first  liga- 
tion of  the  common  iliac  artery  on  record.  This 
was  upon  a  man  who  had  received  a  gunshot 
wound  of  the  abdomen  during  the  riots  in  Balti- 
more. In  addition  to  the  injury  to  the  artery,  the 
intestines  were  wounded  in  two  places,  and  each 
opening  was  closed  with  a  ligature.  The  patient 
died  on  the  fifteenth  day  from  ulceration  of  the 
artery  and  peritonitis,  but  this  operation  estab- 
lished his  reputation  in  surgery.  In  18 14  he  again 
went  to  Europe,  and,  being  in  the  vicinity,  was 
present  at  the  battle  of  Waterloo,  where  he  was 
slightly  wounded.  He  was  also  a  surgeon  to  the 
Maryland  troops  during  the  War  of  1812.  Whilst 
clinical  facilities  were  limited  during  the  time 
that  he  was  professor  of  surgery  in  the  University 
of  Maryland,  he  occasionally  performed  opera- 
tions in  the  presence  of  his  classes  at  the  Maryland 
Hospital  on  Broadway,  which  occupied  the  same 
location  that  is  now  held  by  the  Johns  Hopkins 
Hospital.  He  was  also  surgeon  to  the  Almshouse, 
which  was  located  about  the  present  situation  of 
Howard  and  Madison  streets,  and  at  times  held 


150 


THE    HOSPITAL    BULLETIN 


clinics  at  this  institution.  He  was  said  to  have 
been  an  attractive  teacher,  with  a  distinct  and 
melodious  voice,  and  expressed  himself  in  grace- 
ful and  well-chosen  language.  He  was  a  rapid 
and  dexterous  operator,  and  possessed  great  me- 
chanical ingenuity.  He  was  likewise  a  skillful 
worker  in  wax,  a  fine  artist  and  a  musician  of  no 
small  ability.  He  was  also  a  highly  educated  man 
with  a  predilection  for  the  classics.  In  1819  he 
left  Baltimore  for  Philadelphia,  where  he  had 
been  called  as  professor  of  surgery  in  the  Univer- 
sity of  Pennsylvania.  He  continued  to  fill  this 
chair  until  1854.  He  died  in  Savannah,  Ga.,  on 
.March  2.  1868,  aged  80  years.  He  was  twice 
married,  having  several  children  by  each  wife. 
<  >ne  of  his  sons,  named  Charles  Bell  Gibson,  after 
his  friend.  Sir  Charles  Bell,  the  London  surgeon, 
became  a  distinguished  surgeon  and  professor  in 
the  Washington  University  of  Baltimore,  now 
merged  with  the  College  of  Physicians  and  Sui- 
geons,  and  the  Medical  College  of  Virginia  at 
Richmond.  Dr.  Gibson  was  represented  to  have 
been  of  robust  frame,  broad  shoulders,  full  face 
and  ruddy  complexion.  After  his  removal  to 
Philadelphia  he  became  one  of  the  most  eminent 
surgeons  in  the  United  States,  and  performed 
many  operations  of  great  magnitude  and  impor- 
tance. Amongst  these  was  Caesarean  section  per- 
formed twice  on  the  same  woman,  saving  both 
mother  and  children.  He  also  extracted  a  ball 
from  General  Scott  that  he  received  at  the  battle 
of  Lundv's  Lane  during  the  War  of  1812.  He 
was  the  author  of  an  elaborate  treatise  on  surgery, 
in  two  volumes,  which  went  through  eight  or  nine 
editions.  According  to  Professor  Gross,  he  was 
an  accomplished  lecturer,  lucid  writer  and  able 
surgeon.  The  removal  of  Professor  Gibson  to 
Philadelphia  was  a  great  loss  both  to  the  Univer- 
sity of  Maryland  and  the  city  of  Baltimore.  The 
University  of  Edinburgh,  in  appreciation  of  his 
distinguished  career,  conferred  on  him  the  hon- 
orary decree  of  LL.D. 


THE  ETK  )L(  >GY  <  >F  CHOREA. 


By  II.  D.  McCartv.  M.D.,  of  Baltimore. 

Tn  discussing  the  etiology  of  Chorea  Minor,  I 
beg  to  present  the  following  observations,  which 
have  been  drawn  from  numerous  sources,  and 
though  I  have  been  unable  to  find  anything  con- 
clusive, the  studies  of  the  various  writers,  showing 


the  striking  similarity  of  the  hypotheses  to  which 
they  hold,  strongly  suggest  the  malady  to  be  of 
an  infectious  nature. 

To  those  who  are  interested  in  the  views  of 
earl}-  observers  as  to  the  cause  of  chorea,  I  would 
refer  them  to  an  article  in  The  Johns  Hopkins 
Bulletin,  1901,  by  Dr.  H.  M.  Thomas,  entitled 
"Chorea  With  Embolism  of  the  Central  Artery  of 
the  Retina,"  giving  a  short  review  of  the  embolic 
theory. 

Dr.  Thomas  quotes  Kirkes  in  this  article,  as 
follows :  By  the  mere  circulation  of  morbic  blood 
through  the  nerve  centres  parti}-,  also  by  tempo- 
rary obstruction  in  the  minute  capillaries  occa- 
sioned by  fibrinous  particles  arrested  therein,  the 
irritation  leading  to  the  development  of  chorea  or 
other  analogous  phenomena  may  be  accounted  for. 
In  this  same  article  it  is  stated  Roger,  in  France, 
r886,  went  so  far  as  to  state  that  rheumatism,  cho- 
rea and  endocarditis  were  all  manifestations  of  the 
same  poison. 

I  have  myself  often  thought  whether  chorea 
was  to  be  regarded  as  a  disease  or  as  a  symptom 
of  an  infectious  condition,  in  which,  endocarditis 
and  metastic  arthritis  played  an  essentially  impor- 
tant part. 

Working  in  Dr.  Thomas'  clinic  at  the  Johns 
Hopkins  Dispensary,  I  had  the  opportunity  of  ob- 
serving quite  a  few  cases  of  chorea  minor,  and  one 
could  not  help  be  impressed  with  the  constancy 
with  which  that  malady  was  associated  with  the 
sore  throat,  arthritis  and  endocarditis.  The  tem- 
perature of  the  chorea  patient  was  reguarly  taken 
and  its  absence  rarely  noted. 

Dr.  Thayer,  in  an  analysis  of  808  cases  pub- 
lished in  A.  M.  .1.  Journal,  1906,  showed  in  689 
of  these  cases  that  25.4  per  cent,  had  evidences  of 
cardiac  involvement. 

Wyss — fahrbuch  fur  Kinderheilkunde,  Berlin, 
H)o8 — studied  51  cases  of  chorea  minor  at  Zurich 
(  1874-1Q07).  In  41,  that  is  80.4  per  cent.,  a  cer- 
tain connection  between  chorea  and  acute  articu- 
lar rheumatism  or  endocarditis  was  evident,  either 
in  the  patients  themselves  or  in  their  parents. 
brothers  or  sister.  Rheumatism  had  preceded  cho- 
rea in  16  of  the  51  children,  that  is  in  31.3  per 
cent.,  while  rheumatism  followed  the  chorea  later 
in  40  per  cent,  of  the  35  children,  whose  later  his- 
tory was  known.  Endocarditis  was  observed  at 
the  time  or  later  in  54.3  per  cent,  of  the  51  chronic 
children.  He  calls  chorea,  rheumatism  and  endo- 
carditis the  three  acts  of  a  simile  drama. 


THE    HOSPITAL    BULLETIN 


LSI 


Duckworth — B.  M.  /.,  June  23,  1906 — reit- 
erates his  belief  that  chorea  is  a  variety  of  rheu- 
matism, which  more  particularly  involves  the 
brain.  He  says  that  the  evidence  in  favor  of  the 
rheumatic  nature  of  chorea  is  stronger,  if  possible, 
from  the  clinical  than  from  the  bacteriological 
side.  Chorea  is  more  frequently  seen  in  families 
prone  to  rheumatism.  It  may  precede  .by  months 
or  years  an  onset  of  rheumatic  fever,  or  it  may 
supervene  during  an  attack.  His  statistics  show 
a  family  or  personal  history  in  85  per  cent,  of 
cases  of  chorea. 

Cotton — "Textbook  on  Disease  of  Children," 
1906 — says :  "The  mode  of  onset,  the  self-limi- 
tated  character  of  the  attack,  the  accompanying 
anemia,  the  subsequent  heart  lesions  and  its  tend- 
ency to  recurrence,  all  stamped  chorea  as  a  phase 
of  rheumatism  with  more  than  a  suggestion  of 
microbic  etiology." 

In  "Pfaundler  and  Schlossman's  Textbook  on 
Disease  of  Children,"  1008.  Wollenberg  writes: 
"A  definite  relation  has  been  established  be- 
tween chorea  minor,  rheumatism  and  endocardi- 
tis. This  connection  is  not  observed  in  other 
forms  of  chorea,  and  strongly  suggests  that  chorea 
is  to  be  regarded  as  an  infectious  disease." 

A  few  authors  ( Laufenauer,  Tribuolet,  Bechte- 
rew  and  others)  always  refer  it  an  infectious 
cause,  and  look  upon  the  other  factors  as  exciting 
causes.  Positive  evidence  of  micro-organisms  in 
the  brain  of  choreics  have  been  found  in  but  few 
cases  (results  of  Richter,  Berkley,  Dana,  II. 
Meyer,  Pianese).  1'ianese  found  a  diplococcus 
and  a  diplobacillus,  cultures  of  which  produced  ex- 
perimental chorea. 

Holt  says:  "The  relation  of  chorea  to  rheuma- 
tism is  most  striking,  and  of  late  has  attracted 
much  attention.  The  results  of  different  writers 
are  somewhat  at  variance.  Some  have  found  evi- 
dences of  rheumatism  in  but  a  small  proportion  of 
the  cases  (5.10  per  cent.),  while  others  have 
placed  the  statistics  as  high  as  50  or  60  per  cent. 
I*  is  rather  striking."  Holt  says:  "The  statistics 
of  neurologists,  almost  without  exception,  have 
given  a  very  much  smaller  percenage  of  rheuma- 
ism  in  chorea  cases  than  those  taken  from  chil- 
dren's clinics  and  hospitals."  He  says  the  ques- 
tion hinges  largely  upon  what  is  to  be  considered 
as  evidence  of  rheumatism  in  a  child.  If  cases 
of  acute  articular  inflammation  only,  then  the 
number  will  be  small :  if  subacute  cases,  with 
joint  swelling,  are  included,  the  proportion  will  be 


considerably  larger,  while  if  we  admit  cases  of 
acute  endocarditis  without  articular  symptoms, 
and  those  of  articular  pain  and  joint  stiffness  with- 
out swelling,  the  proportion  will  be  much  in- 
creased. He  believes  there  is  a  close  connection 
between  chorea  and  rheumatic  diathesis  as  mani- 
fested by  symptoms  above  noted  and  accompanied 
by  a  family  history  of  rheumatism.  There  seems 
then  to  be  a  large  group  of  cases  which  may  be 
classed  distinctly  as  rheumatic  chorea.  There  are, 
however,  many  others  in  which  no  such  element 
can  be  found.  , 

The  analysis  of  146  cases  by  Crandall,  quoted 
by  holt,  showed  the  following  result : — 

Definite  history  of  rheumatism,  63  cases. 

Rheumatism  occurred  before  chorea,  41  cases. 

Rheumatism  and  chorea  coincident,  13  cases. 

Rheumatism  subsequent  to  chorea,  9  cases,  usu- 
allv  within  three  months.  In  one-third  of  cases 
attacks  of  rheumatism  occurred  during  or  subse- 
quent to  the  chorea,  as  well  as  before  it.  Then 
previous  rheumatism  was  evident  in  37  per  cent., 
concurrent  in  24  per  cent.,  subsequent  in  15  per 
cent.  Excluding  cases  mentioned  twice  and  all 
those  in  which  there  was  only  a  history  of  growing 
pains,  there  was  evidence  of  articular  rheumatism 
in  56.7  per  cent.  Many  of  these  patients,  Crandall 
states,  have  now  been  under  observation  for  sev- 
eral years,  and  it  has  been  interesting  to  see,  as 
time  has  passed,  how  evidences  of  rheumatic  dia- 
thesis have  multiplied,  the  longer  the  cases  have 
been  observed. 

Holt  says  :  "If  cases  of  endocarditis  without  ar- 
ticular svmptoms  were  included,  as  I  think  they 
might  fairly  be,  it  would  raise  the  proportion  of 
rheumatic  cases  still  higher.  The  great  proportion 
of  cardiac  murmurs  persisting  after  chorea,  if  not 
all  of  them,  should,  1  believe,  be  classed  as  rheu- 
matism, even  if  no  articular  symptoms  have  been 
present. " 

Guthrie  Rankin— B.  M.  /.,  1908 — says:  "The 
peculiar  and  intimate  association  which  exists  be- 
tween chorea,  cardiac  disease  and  rheumatism  is 
well  recognized,  but  the  relationship  has  not  yet 
been  established." 

Morley  Flecher,  quoted  by  Rankin,  concludes 
from  a  study  of  580  cases  that  chorea  is  a  mani- 
festation of  rheumatic  fever,  but  that  many  other 
causes  may  cooperate  in  the  production  of  the 
disease.  Rankin  further  states  when  rheumatism 
attacks  children  it  tends  to  exert  its  influence  more 
on  the  heart  and  pericardium  than  on  the  joints. 


152 


THE    HOSPITAL    BULLETIN 


so  that  if  care  be  not  taken  to  seek  for  evidence  of 
endocarditis  of  pericarditis  the  true  association  of 
chorea  with  the  rheumatic  poison  may  be  over- 
looked. In  fatal  cases  one  or  more  of  the  cardiac 
valves  are  found  diseased,  and  the  interdepend- 
ence of  chorea  and  rheumatism  in  the  vast  major- 
ity of  the  cases  is  now  generally  admitted.  There 
seems  little  doubt  that  both  depend  upon  the  same 
or  closely  allied  micro-organisms. 

Legay  of  Paris  published  statistics  in  1897 
which  went  to  show  that  the  disease  occurs  for 
the  most  part  in  children  with  a  neurotic  heredity 
who  have  recently  suffered  from  an  infectious  dis- 
order. In  the  majority  of  the  instances  the  in- 
fection was  rheumatic,  but  he  quoted  many  cases 
in  which  chorea  was  apparently  directly  due  to 
the  poisons  of  measles,  scarlet  fever,  influenza 
and  tuberculosis. 

Sturges  has  pointed  out  that  it  is  not  an  uncom- 
mon sequelae  of  whooping-cough. 

Nearly  all  writers  agree  as  to  the  age  the  dis- 
ease is  most  common.  It  rarely  occurs  under  5 
years.  Fifty  per  cent,  of  all  cases  are  met  with 
between  5  and  10  years.  Another  30  per  cent,  be- 
tween 10  and  15  years.  It  attacks  girls  three  times 
more  frequently  than  boys,  and  after  the  second 
decade  the  per  centum  of  females  increases. 

Holt  gives  in  14O  cases  6  under  5  years,  7.2 
between  5  and  0  years,  68  between  10  and  14 
years. 

Carpenter,  in  the  B.  M.  J..  1906.  reports  a  case 
of  rheumatism  with  chorea  in  a  child  three  and  a 
half  years  old,  with  hyperpyrexia.  Mitral  murmur 
was  present  and  numerous  subcutaneous  nodules 
the  size  of  small  beans.  Optic  neuritis  later  devel- 
oped, the  child  dying  about  8  weeks  after  the  on- 
set. 

Wollenberg  points  out  that  girls  are  more  often 
attacked  by  severe  forms. 

As  to  season,  it  is  more  prevalent  in  the  cold, 
wet  months.  Holt  says  "it  may  be  seen  at  all 
seasons,  but  is  more  frequent  in  the  spring."  Of 
717  cases  studied  by  Lewis  of  Philadelphia  the 
largest  number  began  in  March.  The  next  largest 
in  May.  In  Holt's  cases  May  stood  first.  Certain 
families  are  specially  predisposed ;  mostly  those 
in  which  a  rheumatic  and  neurotic  inheritance 
are  combined. 

Rankin  states  a  general  nervous  disposition  is 
noted  in  20.30  per  cent  of  cases.  He  further 
states  the  relation  between  neuropathia  and  cho- 
rea is  bv  no  means  clear.     It  is  not  to  be  denied 


that  febrile  diseases  or  chronic  nutritional  disturb- 
ances, which  lower  the  resistance  of  the  entire  or- 
ganism, and  therefore  of  the  nervous  system, 
might  produce  a  certain  predisposition  to  the  in- 
toxication or  infection  which  manifests  itself  as 
chorea. 

By  some  writers  reflex  irritation,  such  as  that 
produced  by  dentition,  intestinal  worms,  errors  of 
refraction,  etc.,  is  held  responsible  for  choreic 
manifestations. 

It  must  be  borne  in  mind  that  much  confusion 
has  existed  in  the  minds  of  many  as  to  what  is  to 
be  called  chorea,  and  no  doubt  that  irregular 
movements  arising  from  above-mentioned  irrita- 
tion might  be  tics  pure  and  simple.  1  would  direct 
your  attention  to  differential  points  cited  by  Meige 
and  Feindal  in  their  book  on  "Tics  and  Their 
Treatment." 

Children  who  have  suffered  from  one  attack 
are  liable  to  a  recurrence.  Rankin  states  the  prox- 
imate cause  is  probably  a  micro-organism  similar 
to  that  of  rheumatism,  the  toxins  of  which  are  re- 
sponsible for  the  nervous  manifestations  with 
which  we  are  familiar ;  but  even  if  this  hypothesis 
be  ultimately  confirmed,  it  must  be  admitted  that 
the  direct  excitant  of  an  attack  is  in  many  in- 
stances some  form  of  mental  disturbance.  In  chil- 
dren fright  is  the  most  acute  of  all  emotional 
states,  but  it  is  conceivable  that  excessive  joy  or 
sorrow  may  act  in  a  similar  detrimental  way  on 
those  suitably  predisposed.  It  is  not  impossible 
that  the  emotional  excitant  may  be  responsible 
for  two  varieties  of  the  disease,  according  as  the 
child  harbors  the  rheumatic  micro-organism  or 
not ;  that  in  one  instance,  and  that  the  more  fre- 
quent, it  may  be  rheumatic  manifestation  and  in 
the  other  neurotic. 

Gowers  states  that  25  per  cent,  of  all  cases  are 
due  to  fright,  and  that  in  his  experience  the  in- 
terval between  the  fright  and  the  development  of 
muscular  movements  rarely  exceeds  a  week. 

Sturges  (and  many  observers  agree  with  him) 
regards  the  disease  as  a  functional  expression  of 
nerve  irritability  induced  by  numerous  extrane- 
ous causes,  and  urges  in  favor  of  this  view  the  re- 
markable limitation  of  the  disease  to  the  period  of 
childhood,  its  preference  for  females,  and  its  on- 
set at  a  time  when  the  requirements  of  growth 
and  education  are  exciting  a  strong  demand  upon 
the  resisting  power  of  the  sensori-motor  ganglia. 

Finally,  there  are  not  wanting  advocates  of  the 
microbic  origin  of  the  disease,  and  it  has  been 


THE    HOSPITAL    BULLETIN 


153 


found  that  the  diplococcus,  isloated  by  Poynton 
and  Payne  from  the  joints  of  patients  with  acute 
rheumatism,  is  capable  of  producing,  when  in- 
jected into  rabits,  not  only  arthritis,  but  endocardi- 
tis ;  but  in  some  instances  also  a  form  of  chorea. 
Sections  of  the  cerebral  cortex  of  an  animal  thus 
rendered  choreic  have  revealed  masses  of  diplo- 
cocci  in  connection  with  the  small  arterioles.  The 
probable  entry  of  the  organisms  through  the  deli- 
cate mucous  membrane  of  the  naso-pharynx  has 
been  suggested  as  a  possible  explanation  of  how 
infection  may  occur,  and  there  can  be  no  doubt 
that  the  disease  occurs  in  association  with  several 
types  of  sore  throat. 

M.  de  Ponthiere  ( "Annales  de  Medecine  et 
Chirurgie  Infantiles,"  Paris)  :  After  ten  years' 
observations,  comments  on  the  rapid  and  perma- 
nent cures  obtained  by  removal  of  tonsils  and 
adenoids  which  are  chronically  affected,  his  con- 
clusions are  that  chorea  is  generally  the  outcome 
of  an  auto-intoxication  produced  by  swallowing 
septic  material  secreted  by  the  lymphoid  organs  of 
the  naso-pharynx.  The  naso-pharyngeal  infection 
is  nearly  always  rheumatic.  The  pharynx  is 
nearly  always  responsible  for  the  cardiac  and  arth- 
ritic manifestations  of  rheumatism  which  follow 
on  septic  sore  throats.  The  author  adduces  the 
analogy  of  other  local  and  general  symptoms 
which  are  common  to  adenoid  and  choreic  pa- 
tients, such  as  deficient  nasal  respiration,  disturbed 
nights,  night  terrors,  dyspnea,  muscular  and  intel- 
lectual disabilities,  difficulty  in  concentrating  the 
attention,  alterations  in  the  character,  digestive 
disturbance,  distaste  for  food,  especially  in  the 
morning;  lymphatism,  and  the  stupid  aspect  of 
the  choreic,  which  is  the  same  as  the  adenoid  fa- 
cies.  The  examination  of  the  naso-pharynx  is 
thus  of  the  greatest  importance  in  cases  of  chorea, 
as  the  origin  of  the  neurosis  will  be  often  dis- 
covered there. 

The  influence  on  chorea  of  suitable  treatment  of 
the  nose  and  throat  will  convince  the  most  skep- 
tical, he  says,  of  the  unmistakable  connection  be- 
tween them. 

In  connection  with  the  possibility  of  chorea  be- 
ing due  to  a  toxin,  I  would  like  to  call  attention  to 
the  experiments  by  Phisalix  on  sparrows.  He 
found  that  the  bee  sting  produced  in  them  true 
choreiform  movements,  in  which  the  muscles  of 
the  feet,  head,  wings  and  eyes  were  affected. 

The  association  of  chorea  with  pregnancy  is  by 
no  means  rare.     It  seems  to  occur  in  those  who 


have  had  chorea  or  some  manifestation  of  rheu- 
matism previously. 

In  the  Deutsche  Medisinische  Wochenschrift, 
Berlin  and  Leipsic,  1906,  Martin  reports  a  case  of 
chorea  with  pregnancy.  During  the  first  preg- 
nancy the  patient  had  acute  articular  rheumatism. 
The  subsequent  pregnancies  were  attended  with 
chorea,  which  reappeared  with  each  succeeding 
pregnancy  with  increased  intensity. 

From  the  facts  that  chorea  occurs  more  fre- 
quently during  that  season  of  the  year  when  the 
mucous  membranes  are  mostly  to  be  infected,  oc- 
curring in  children  at  that  period  of  life  when  they 
are  most  liable  to  throat  trouble ;  the  disease  being 
many  times  associated  with  conditions  known  to 
be  infectious  ;  the  febrile  course  of  the  disease  ;  all 
strongly  point  toward  chorea  being  an  infectious 
r.ialadv. 


CORRESPONDENCE 

A  TRIP  TO  RICHMOND,  THE  CAPITAL  OP 
THE  COMMONWEALTH  OP  VIRGINIA 
AND  THE  SECOND  CAPITAL  OF  THE 
CONFEDERACY, PETERSBURG  AND  WIL- 
LIAMSBURG. THE  SECOND  CAPITAL 
OF  VIRGINIA. 

Editor  of  Bulletin. 

Embarking  on  the  good  steamer  Atlanta  of  the 
York  River  Line  I  left  Baltimore,  Saturday,  July 
Ml,  1909,  ;it  "<  1'.  M..  and  sailed  down  that  magnifi- 
cent body  of  water,  the  Chesapeake,  reaching  West 
Point,  Virginia,  the  next  morning  at  8  A.M., 
thence  entrained  on  the  Southern  Railroad  and 
reached  my  destination  at  9.30  A.  M.  The  country 
I iet ween  the  York  and  the  James  Rivers,  is  flat, 
sandy  and  not  well  cultivated,  but  pleasing  to  the 
eye ;  only  here  and  there  did  I  see  fields  of  corn, 
nor  is  it  apparently  thickly  populated.  The 
greater  part  of  the  train  trip  was  passed  through 
scrub  woods  of  pine,  oak,  holly,  etc.  The  journey 
took  us  over  the  Pamunkey,  a  broad,  shallow, 
picturesque  river  and  a  feeder  of  the  York.  Rich- 
mond, founded  in  1737  by  Colonel  William  Byrd 
and  incorporated  as  a  town  (17-42),  is  at  the  head 
of  tidewater  and  navigation.  Situated  on  the 
north  bank  of  the  James  on  a  series  of  terraced 
hills,  it  contains  much  of  historic  value  to  interest 
the  stranger.  The  panorama,  from  the  Seven 
Hills,  of  the  Valley  and  of  the  Falls  of  the  James 


154 


THE    HOSPITAL    BULLETIN 


is  superb  and  pleasing.  Here  John  Smith  and  a 
companion  landed  after  they  had  left  their  fol- 
lowers at  Jamestown  Island — the  first  capital  of 
Virginia — the  Falls  of  the  James  barring  further 
progress  to  their  journey. 

During  the  Revolutionary  War  La  Fayette  had 
his  headquarters  for  a  time  in  the  city  of  Rich- 
mond, the  building,  an  old  stone  house,  being  still 
in  an  excellent  state  of  preservation  and  located  in 
the  eastern  section  or  old  part  of  the  city.  It  is 
claimed  that  Washington  visited  the  Count  in  this 
building,  whence  it  is  called  Washington's  head- 
quarters. Tarlton  and  Arnold  during  the  Revolu- 
tion raided  as  far  inland  as  Richmond. 

But  it  is  the  stirring  and  eventful  part  Rich- 
mond played  in  the  Civil  War  that  chiefly  con- 
cerns the  visitor.  Here  many  of  the  Confederate 
soldiers  of  the  Civil  War  were  mustered  into 
service;  here  the  last  scenes  of  that  great  contesl 
culminated  in  the  disaster  and  ruin  that  left  large 
sections  of  the  city  in  ashes:  here  today  one  sees 
everywhere  the  results  of  the  energy  which  has  ef- 
faced the  signs  of  those  troublous  times:  and  the 
enterprises  which  have  tripled  the  population, 
which  is  now  rated  as  125,000,  against  37,910  in 
1860. 

The  White  House  of  the  Confederacy,  the  war 
time  residence  of  the  Confederate  President.  Jef- 
ferson Davis,  at  the  coiner  of  Twelfth  and  Clay 
streets,  is  now  a  Confederate  Museum  and  Memo- 
rial Building.  The  house,  an  old  fashioned  resi- 
dence, was  built  in  1819,  and  bought  by  the  city  of 
Richmond  for  the  use  of  the  Confederate  Govern- 
ment. During  the  Federal  occupation  it  was  used 
by  General  Witzel  as  headquarters,  but  with  the 
revocation  id'  martial  law,  the  city  of  Richmond  es- 
tablished its  first  public  school  in  it:  for  which 
purpose  it  was  employed  until  1890,  when  it  was 
turned  over  to  the  Confederate  Memorial  Literary 
Society,  who  have  entirely  renovated  the  building 
and  restored  it  to  its  erstwhile  appearance.  With 
but  one  or  two  exceptions  no  relic  has  been  pur- 
chased. Each  Confederate  State  is  represented  by 
a  Room,  set  apart  as  a  memorial  to  her  sons  and 
their  deeds.  The  relics  and  books  are  invaluable 
and  a  fitting  testimonial  to  the  valor  and  manhood 
of  our  Southland.  In  order  to  meet  running  ex- 
penses an  admission  of  25  cents  is  charged. 

St.  Paul's  Church,  at  the  corner  of  Grace  and 
Ninth  streets,  is  of  interest.  I'm'  here  it  was  Presi- 
dent Davis  while  at  worship  received  news  from 
Lee  that  the  city  must  be  evacuated.     In  this  build- 


ing are  memorial  windows  erected  to  the  memory 
of  Lee  and  Davis.  Lee's  old  headquarters  are  on 
Franklin  street  between  Seventh  and  Eighth.  The 
famous  Libby  Prison  has  been  removed  to  Chicago 
and  a  factory  erected  on  its  site. 

In  Hollywood  Cemetery,  so  called  from  the 
abundant  and  luxuriant  growth  of  holly,  at  the 
western  edge  of  the  city  are  buried  Davis,  Pickett, 
Stuart,  Presidents  Monroe,  Tyler  and  Madison  and 
many  other  distinguished  personages.  Here  is  to 
lie  -een  a  massive  pyramid  of  stone  erected  to  the 
memory  of  the  Confederate  dead  and  monuments 
upon  the  burial  sites  of  those  just  mentioned.  We 
of  the  South  should  feel  an  especial  gratification  in 
the  beautiful  and  quiet  resting  place  of  President 
Davis. 

Capitol  Square  enclosing  ten  acres  of  ground  is 
a  beautiful  spot,  adorned  with  trees,  flowers,  foun- 
tains, and  historic  buildings.  Here  upon  an  eleva- 
tion, is  located  the  Capitol,  plain  in  character,  with 
walls  of  stuccoed  bricks  and  a  portico  with  mas- 
sive columns,  and  designed  after  the  Pantheon. 
Within  its  walls  the  Confederate  Congress  met.  In 
the  Rotunda  is  Houdon's  celebrated  Statue  of 
George  Washington.  It  houses  the  offices  of  the 
Governor,  and  a  room  in  which  there  is  an  exhibit 
of  the  products  of  Virginia.  In  this  building  is 
also  to  be  seen  the  speaker's  chair  from  the  Colo- 
nial House  of  Burgesses. 

Besides  the  Capitol  this  square  contains  within 
its  enclosure,  the  Governor's  Mansion,  colonial  in 
style,  the  Library  Building,  recently  completed. 
Washington,  Clay.  Smith.  Jackson  and  Hunter  Mc- 
Guire  Monuments,  and  the  old  Bell  House.  On 
Franklin  street  are  to  lie  seen  monuments  to  Lee, 
Davis  and  J.  E.  B.  Stuart.  Many  other  objects 
and  points  of  interest  abound.  Old  St.  John's 
Church,  where  Patrick  Henry  delivered  his  famous 
speech  "Give  me  liberty  or  give  me  death"  is 
open  to  strangers  free  of  charge.  If  you  are  look- 
ing for  historical  places  and  incidents,  go  to  Rich- 
mond.    Here  you  will  get  your  surfeit. 

From  a  material  standpoint  Richmond  is  also 
interesting  to  the  traveler :  nearly  forty-five  years 
ago  it  was  almost  annihilated  by  fire.  Today,  are 
to  be  seen  no  traces  of  this  great  conflagration, 
factories,  stores,  public  buildings  not  only  cover 
the  destroyed  area,  but  extend  miles  in  other  direc- 
tions. It  is  above  all  a  clean  city,  and  is  away 
ahead  of  Baltimore  in  this  respect.  Its  streets  are 
paved  either  with  asphalt  or  belgium  blocks,  oc- 
casionally  with   vitrified    bricks.      No   cobblestones 


THE    HOSPITAL    BULLETIN 


155 


are  to  be  seen.  Much  to  her  credit  there  is  no  sur- 
face drainage.  Baltimore  could  indeed  take  a  les- 
son. The  number  of  two-stoTy  houses  are  striking. 
There  are  some  modern  residences  in  the  western 
part  of  the  town.  On  Grace  street,  the  aristocratic 
neighborhood,  the  houses  are  no  two  alike,  colonial 
in  structure  mostly,  with  some  veranda,  and  sur- 
rounded with  a  little  grass  or  flower  plot.  Even 
the  less  pretentious  houses  have  some  ground  in 
front  of  them  and  I  did  not  see  in  the  residential 
quarter  during  my  stay  a  solid  row  of  houses  such 
as  we  have  in  Baltimore. 

Crepe  Myrtle,  in  bloom,  and  magnolia  trees  are 

to  be  seen  on  every  side.  The  holly  and  fig 
tree  flourish  here  as  nowhere  else.  Hotel  accom- 
modations are  good  and  reasonable.  For  visitors 
bent  on  sight  seeing  the  Murphy  or  the  Richmond 
Hotel  are  centrally  located,  their  rates  moderate 
and  service  excellent.  The  street  car  service  is  un- 
excelled, and  reaches  all  points  of  interest,  as  well 
as  surrounding  suburbs.  Transfers  are  freely  is- 
sued and  a  transfer  is  given  on  a  transfer.  Rich- 
mond is  however  poorly  lighted. 

Of  no  doubt  of  more  importance  to  you,  as  medi- 
cal men.  will  be  a  short  account  of  the  medical 
colleges  of  Richmond,  of  which  there  are  two.  the 
Medical  College  of  Virginia,  the  older,  and  the 
University  College  of  Medicine,  the  younger  of  the 

two.  and  an  offsl t  of  the  former.     Both  embrace 

departments  of  medicine,  dentistry  and  pharmacy, 
and  both  have  a  student  enrollment  of  approxi- 
mately 350. 

The  Medical  College  of  Virginia,  is  located  at 
the  corner  of  Marshall  and  College  streets.  It  was 
founded  in  the  year  1838.  At  first  this  institution 
was  a  part  of  Hampden-Sidney  College,  but  in 
1854  it  was  chartered  as  a  separate  institution.  It 
has  a  continuity  of  existence  as  its  doors  were  not 
closed  during  the  war  between  the  states.  The 
main  building,  modeled  after  the  Egyptian  style  of 
architecture,  is  large  and  imposing.  In  it  there 
are  a  number  of  classrooms.  The  laboratories  are 
in  another  building,  the  former  old  Dominion 
Hospital,  the  clinical  instruction  now  being  given 
in  Memorial  Hospital,  an  imposing  structure, 
corner  Twelfth  and  Broad  streets.  This  hospital 
is  built  externally  of  terra  cotta  bricks.  Its  in- 
terior is  tastefully  arranged  and  furnished,  its 
amphitheatre  roomy  and  its  walls  partially  tiled, 
the  floor  of  terrazza.  There  are  several  other 
operating  rooms,  an  excellent  and  up-to-date  X-ray 
and  electro  therapeutic  outfit.      This  hospital  holds 


about  150  patients  when  full.  As  the  State  of 
Virginia  and  the  City  of  Richmond  make  no  pro- 
vision for  charity  cases  this  hospital  as  well  as 
Virginia  Hospital  connected  with  the  University 
College  of  Medicine,  are  forced  to  curtail  their  run- 
ning expenses  and  during  the  summer  months  arc 
obliged  to  close  their  public  wards.  The  wards 
are  large,  well  ventilated  and  comfortable,  and  the 
private  rooms  which  range  in  price  from  7  to  as 
high  as  25  dollars  per  week  are  very  attractive. 
The  kitchen  is  on  the  top  floor.  Here  I  saw  a 
slight  operation  by  Dr.  Horslev.  a  rising  young 
surgeon  of  Richmond.  The  technique  was  excel- 
lent and  all  concerned  seemed  to  be  familiar  with 
their  part. 

Coming  hack  to  the  school  the  laboratories  were 
fairly  well  equipped  and  ought  to  be  able  to  do 
good  work.  A  small  library  attached  to  this  in- 
stitution was  housed  in  a  Large  room,  but  as  far 
as  I  know  had  no  regular  librarian.  The  dis- 
pensary  was  in  the  basement  of  the  laboratory 
building.  Considering  that  the  school  is  not  en- 
dowed, it  should  and  in  all  probability  is  doing 
good  work.  1  was  very  much  impressed  with  its 
appearance  and  its  potentialities.  Mr.  McCauley, 
the  secretary  of  the  Board  was  very  attentive  and 
courteously  showed  me  through  the  buildings.  He 
also  explained  to  me  the  inner  workings  of  his 
office  and  I  assure  you  it  was  very  business  like. 
As  far  as  possible  he  keeps  a  card  index  system  of 
the  address  of  each  and  every  graduate.  The 
grades  arc  kept  on  the  loose  leaf  ledger  system 
and  at  the  end  of  the  fourth  year,  these  are  bound 
into  a  volume  and  filed  away. 

The  University  College  of  Medicine,  founded  in 
1893,  is  housed  on  Clay  and  Twelfth  streets.  It 
was  chartered  as  a  joint  stock  company,  hut  in 
10()4  another  (barter  was  conferred  upon  it,  chang- 
ing it  from  a  private  enterprise  to  an  institution 
governed  by  an  independent  hoard  of  trustees. 
The  buildings  are  large  and  occupy  approximately 
half  id'  a  city  block.  The  lecture  rooms  are  com- 
modious and  the  laboratories  should  apparently  be 
able  to  render  a  good  account  of  themselves.  In 
this  institution  there  was  a  Pasteur  department. 
On  the  whole  the  appearance  of  the  buildings  did 
not  strike  me  as  favorably  as  those  of  the  Medical 
College  of  Virginia.  The  Virginia  Hospital,  the 
clinical  part  of  the  institution  was  housed  in  two 
old  colonial  houses  which  bail  bad  their  dividing 
partition  knocked  out,  and  enlarged  as  occasion 
demanded  by  several  additions.      The  private  rooms 


K6 


THE    HOSPITAL    BULLETIN 


appeared    cosy   and   comfortable,   the   wards   well 

kept,  and  the  whole  institution  was  in  shipshape 
order.  Here  I  saw  a  case  of  pellagra,  and  a 
colored  woman  recovering  from  a  decompression 
operation.  Both  the  Hospital  and  the  University, 
however,  had  the  air  as  if  they  were  suffering  from 
hampered  finances. 


PETERSBURG. 
Petersburg  is  to  the  south  of  Richmond  and  con- 
veniently reached  either  by  the  14th  or  7th  street 
trolley  for  Manchester,  where  a  change  is  made 
to  the  Petersburg  line.  The  price  of  the  trip  is 
40  cents  each  way.  This  town  is  situated  on  the 
banks  of  the  Appamatox  River.  It  is  hilly.  More 
space  intervenes  between  the  houses,  but  it  is 
smaller  than  Richmond.  The  remains  of  the 
Crater,  filled  with  trees,  whose  trunks  in  some  in- 
stances are  as  large  as  a  man's  body,  is  to  be  seen. 
Old  Blandford  church  near  the  Crater  and  in 
which  are  buried  some  of  the  victims  of  this  en- 
gagement, is  well  worth  inspecting;  memorial 
tablets  and  windows  being  numerous.  One  of  the 
windows  is  to  the  North  Carolina  troops,  of  whom 
more  than  45,000  were  killed  during  the  war,  with 
Lee's  epitaph,  "Cod  bless  North  Carolina."  The 
court  house  is  a  quaint  old  building.  There  were 
some  very  pretty  and  pretentious  homes  in  this 
city. 


WILLIAMSBURG. 

Williamsburg  the  second  colonial  capital,  is  in- 
deed a  very  interesting,  instructive  and  entertain- 
ing spot.  Situated  on  the  peninsula  between  the 
York  and  James  Rivers,  it  is  reached  from  Rich- 
mond by  the  Chesapeake  and  Ohio  Railroad,  the 
ticket  being  $1.20  each  way.  It  is  about  seven 
miles  from  Jamestown  Island.  In  1699,  owing  to 
the  burning  of  the  State  House  at  Jamestown,  the 
seat  of  government  was  removed  to  Williamsburg. 
The  remains  of  Martha  Washington's  kitchen, 
namely  the  chimney,  is  still  standing.  The  old 
Court  House  is  an  object  of  interest.  William  and 
Mary  College,  founded  in  1693,  is  located  in  this 
town.  The  main  building  was  fired  by  the 
Federals  and  almost  completely  destroyed.  As 
far  as  possible  in  the  rebuilding  the  old  walls  anil 
bricks  were  used.  The  buildings  of  this  institu- 
tion are  very  quaint.  Many  distinguished  men 
have  been  students  at  William  and  Mary,  among 
whom  may  be  mentioned  Patrick  Henry,  Chief 
Justice  Marshall,  President  Monroe,  General  Win- 


field  Scott.  It  was  in  this  town  that  the  im- 
mortal George  Washington  first  met  his  future 
wife,  Mrs.  Custis. 

The  foundation  of  the  House  of  Burgesses  is 
still  to  be  traced,  and  a  tablet  marks  the  spot.  The 
crowning  glory  of  Williamsburg,  however,  is  Bru- 
ton  Church,  the  oldest  Episcopal  Church  in  con- 
tinuous service  in  America.  Here  five  presidents 
have  worshipped:  Washington,  Jefferson,  Madi- 
son, Monroe  and  Tyler.  During  colonial  times  the 
Governor  and  members  of  the  House  of  Burgesses 
worshipped  here.  King  Edward  recently  pre- 
sented a  bible  to  the  church  and  President  Roose- 
velt has  given  an  electra  on  which  the  bible  is  to 
rest.  The  church  is  constructed  on  the  plan  of  a 
letter  H  and  is  finished  with  a  mahogany  effect. 
The  pews  are  dedicated  to  the  worthies  of  the  past, 
many  of  whom  are  buried  under  the  floors.  The 
janitor,  William,  a  colored  man,  was  very  polite. 
He  had  at  his  finger's  end  the  life  history  of  each 
and  every  celebrity  whose  life  had  happened  to  be 
interlinked  with  that  of  the  church.  Washington's 
step-children  are  interred  in  the  churchyard.  In 
I  his  town  is  also  to  be  seen  Washington's  head- 
quarters, the  Old  Powder  Horn,  wherein  the  am- 
munition was  stored — it  has  now-  been  converted 
into  a  Colonial  Museum — and  the  Eastern  State 
Hospital,  the  first  insane  hospital  in  the  United 
States. 

Natiiax  Winslow. 


To  the  Editor  : 

Why  not  a  "Booster  Club"  or  "Praise  Your 
Brother  Club"  in  the  American  Medical  Associa- 
tion, with  no  dues  or  other  requirements  except 
that  each  member  pledge  himself  never  to  speak 
unkindly  or  in  criticism  of  a  brother  physician 
to  the  laity,  except  that  physician  be  also  present. 
Let  us  renew  our  vows  and  wear  buttons  to  show 
that  we  mean  to  keej>  them. 

If  such  a  condition  could  be  brought  about  we 
would  he  held  in  much  greater  esteem  by  our 
patients  and  neighbors.  Whenever  a  physician  is 
condemned,  maligned  or  criticised  by  another  phy- 
sician, the  ill-will  engendered  in  the  minds  of  the 
laity  is  not  against  the  one  physician,  but  the  class; 
individuals  are  forgotten  and  the  profession  is  re- 
membered as  a  whole.  If  I  tell  every  one  I  meet 
that  Dr.  Pill  is  a  rank  physician ;  knows  nothing 
of  medicine  and  will  stoop  to  any  mean  practice, 
the   laity   soon    forget   that    Dr.    Pill   is   a   "poor 


THE    HOSPITAL    BULLETIN 


1 57 


doctor"    and    retain   the    impression   that   we   are 
all  "poor  doctors"  ready  to  stoop  to  anything. 

Let's  stop  it;  raise  the  standard.     Can  we  get 
together  at  St.  Louis  and  organize  a  club? 
Yours  for  "no  knocking," 
W.  T.  Woottox.  M.  D., 

Hot  Springs,  Ark. 
The  above  from  the  Journal  A.  M.  A.  of  Au- 
gust 7th,  '09. 

Will  you  agitate  such  a  scheme  to  the  end  that 
we  may  create  a  better  general  impression  upon 
the  laity,  restore  confidence  in  our  profession  and 
take  away  the  foundation  for  so  many  pathics. 
religeo-cures,  etc.? 

Very  sincerely  yours, 

W.    T.   WoOTTON. 

The  Bulletin  will  be  glad  to  receive  members 
to  Dr.  Wootton's  club. 


ITEMS 

Doctor  Joshua  W.  Hering  has  been  renominated 
as  State  Comptroller  by  the  Democratic  Organiza- 
tion of  Maryland.  Doctor  Hering  was  a  member 
of  the  class  of  ls.")o.  and  is  a  resident  of  West- 
minster, Maryland. 


Doctor  W.  M.   Pearce  is  spending  his  summer 
vacation  at  Atlantic  City  with  his  family. 


Doctor  John  I'.  Winslow,  Clinical  Professor 
of  Diseases  of  Nose  and  Throat,  has  returned  from 
his  summer  vacation,  which  was  spent  at  Cape 
May,  New  Jersey. 


Doctor  C.  W.  McElfresh,  Clinical  Professor  of 
Medicine,  lias  returned  from  his  summer  vaca- 
tion, which  embraced  a  trip  to  West  Virginia 
and  Pittsburg.  In  the  latter  city  he  saw  some  good 
work  in  cranial  surgery. 


Doctor  Randolph  Winslow,  Professor  of  sur- 
gery, has  left  on  a  trip  to  the  Mayo  brothers  in 
Rochester,  Minnesota.  He  will  be  accompanied 
by  Doctor  Robert  Bay,  superintendent  of  the  Uni- 
versity Hospital. 


Doctor  and  Mrs.  Nathan  Winslow  have  returned 
from  Richmond,  where  they  spent  some  time  vis- 
iting points  of  historic  interest.  An  account  of 
the  trip  appears  elsewhere  in  this  number. 


University  Hospital,  is  located  at  Sandy  Spring, 
Montgomery  county,  Maryland.  It  was  the  pleas- 
ure of  one  of  the  editors  to  pay  him  a  flying 
trip  and  he  appears  to  he  making  a  success  of 
practice. 


Doctor  Walter  Scott  Carswell  is  stopping  at  the 
Chalfonte,  Atlantic  City. 


Doctor  and  Mrs.  Norman  F.  Hill  have  returned 
to  Baltimore  from  a  visit  to  their  son,  at  Buffalo, 
New  York,  and  will  move  to  their  apartments  at 
the  Walbert,  September  1,  1909. 


Doctor  John  C.  Keaton,  class  of  1907,  of  Quiucy, 
Florida,  is  the  guest  of  Doctor  J.  L.  Valentini, 
130-.'   N.  Broadway,   Baltimore. 


Doctor  John  A.  Tompkins  has  returned  to  his 
home  after  a  fortnight's  stay  at  liar  Harbor,  where 
Mrs.  Tompkins  is  spending  the  summer. 


Doctor  Ariste  W.  Giampietro,  class  of  1907,  of 

Baltimore,  lias  been  appointed  physiologist  in  the 
Bureau  of  Plant  Industry,  at  Washington. 

Doctor  Gianpietro  is  38  years  of  age  ami  prom- 
inent among  the  Italian  contingent  of  the  city. 
lie  is  the  organizer  and  head  of  the  Republican 
Organization  known  as  "Young  Italy."  He  lives 
at  3007  Baker  street.  Walhrook,  Baltimore.  The 
appointment  came  as  the  result  of  the  successful 
passing  of  a  civil  service  examination. 


We  are  more  than  glad  to  announce  to  the  many 
friends  of  Doctor  Lawrence  Kolh.  class  of  1908, 
and  an  ex-resident  of  the  University  Hospital, 
where  he  did  exceptionally  good  work,  that  he  has 
passed  the  examination  for  the  Public  Health  and 
Marine  Hospital  Service,  and  has  received  a  com- 
mission as  assistant  surgeon.  He  has  been  or- 
dered to  report  to  medical  officer  in  charge  at 
Baltimore  for  assignment  to  dulv. 


Doctor  and  Mrs.  J.  Frank  Crouch  have  left 
Bretton  Woods,  New  Hampshire,  and  will  spend 
several  weeks  at  Lenox,  Massachusetts. 


Doctor   and    Mrs.    Francis   Jannev,    of    Catons- 
ville,  Maryland,  are  at  Atlantic  City. 


Doctor  J.  W.  Bird,  ex-resident  physician  to  the 


Doctor  Fitz  Randolph  Winslow.  class  of   190G, 
spent  his  vacation  at  Lurav  Cave,  Virginia. 


THE    HOSPITAL    BULLETIN 


Dr.  William   K.  White,  class  of  1902,  who  was 
operated  on  recently  at  the   University   Hospital, 

has  made  a  g I  recovery  and  left  the  institution. 

Doctor  White  is  one-of  the  mosl  popular  of  the 
younger  physicians  connected  with  the  University 
Hospital  and  the  news  of  his  recovery  will  be 
h  elcomed  by  his  many  h  tends. 


Doctor  A.  G.  Pole  and  family,  of  Baltimore, 
have  left  for  Atlantic  City,  where  they  will  be 
the  guests  of  the  Chalfonte  for  several  weeks. 

Doctor  William  IT.  Smith,  'class  of  1900,  ex- 
resident  physician  and  surgeon  to  the  University 
Hospital,  and  formerly  superintendent  of  the  He- 
brew and  Bay  View  Hospitals,  broke  his  leg  re- 
cently while  engaged  in  a  game  of  baseball  between 
the  internes  and  the  dispensary  staff. 


Doctors  J.  X.  Reik  and  T.  Chow  Wbrthington 
have  sailed  for  Europe,  where  they  will  attend 
the  meetings  of  the  International  Medical  Con- 
gress at  Budapest  in  September.  After  visiting 
Switzerland  and  France  they  will  return  home 
about  October  l.   1909. 


Doctor  Frank  Martin,  who  is  travelling  in  Eu- 
rope, expects  tn  return  to  his  home  the  early  part 
of  <  October. 


Doctor  Frank  Lynn,  class  of  1907,  will  sail  for 
Europe  during  the  latter  part  of  September,  where 
he  will  devote  his  time  to  pathological  and  sur- 
gical investigation. 


Doctor  M.  -L  McKhmon,  class  of  1853,  a  ven- 
erable and  prominent  physician  of  York.  Penn- 
sylvania, besides  one  of  the  oldest  living  alumni 
of  the  University  of  Maryland,  is  critically  ill  at 
his  home  in  York. 


The  following  of  our  alumni  are  members  of 
the  Board  of  Trustees  of  the  Medical  and  Chirur- 
gical  Faculty  of  Maryland  : 

S.  C.  Chew. 

.1.  W.  Humrichouse. 

L.  McLane  Tiffany. 

Wilmer  Brinton. 

(J.  Lane  Taneyhill,  Sr. 

I).  E.  St, 


retary  and  treasurer  of  the  Maryland  State  Board 
of  Medical  Examiners,  has  made  public  the  names 
of  those  candidates  who  were  successful  in  the 
June  examination.  Those  of  our  alumni  who 
passed  : 

Clarence  I.  Benson. 

X.  I.  Broadwater. 

William  S.  Campbell. 

Clarence   B.   Collins. 

Arthur  L.  Fehsenfeldt. 

Harry  B.  Gantt,  Jr. 

Richard   II.  Gantt. 

Joseph   W.  Hooper. 

Joseph    I.    Lender. 

I  low  anl    Kerns. 

Samuel  II.  Long. 

James  B.  Magraw. 

William  E.  Martin. 

John  J.  McGarrell. 

James  B.   Parramore. 

Samuel  .1.   Price. 

Wilmer  II.  Priest. 

William  G.  Queen. 

Harry  A.   Hut  ledge. 

I  (ceil  A.  Shankwiler. 

Claude  ( '.   Smitlk. 

Maurice  I.  Stein. 

Charles  F.  Strosnider. 

Alfred   C.  Trull. 

Frederick  C.  Warring. 


Doctor  J.  McPherson  Scott,  of  Hagerstown,  sec- 


The  following  of  our  alumni   have  been   presi- 
dent of  the  Medical  and  ( 'hii  urgical  Faculty: 
Doctors — 

Fnnalls  Martin,  class  of    1818. 
Robert  Moore,  class  of  1819. 
Robert  Goldsborough,  class  of  1820. 
Maxwell    McDowell,   class   of    1818. 
Joel  Hopkins,  class  of  1815. 
Richard  Sprigg  Steuart,  class  of  1822. 
Peregrine  Wroth,  class  of  1841. 
William  W.  Handy,  class  of  1819. 
Michael  S.  Baer,  class  of  1818. 
John  L.  Yates,  class  of  1822. 
John  Fornerden,  class  of  1823. 
Joshua   I.  Cohen,  class  of  1823. 
George  C.  M.  Roberts,  class  of  1826. 
Nathan  K.  Smith,  Professor  of  Surgery. 
Charles  II.  Ohr,  class  of  1834. 
Henry  M.  Wilson,  class  of   1850. 
John  M.  Monmonier,  class  of  1834. 
Christopher  Johnston,  class  of  1844. 


THE    HOSPITAL    BULLETIN 


159 


Samuel  P.  Smith,  class  of  1817. 

Samuel  C.  Chew,  class  of  1858. 

H.  P.  C.  Wilson,  class  of  1851. 

Frank  Donaldson,  class  of  1846. 

Richard  MeSherry,  class  of  1880. 

Thomas  S.  Latimer,  class  of  1861. 

George  W.  Miltenberger,  class  of  1840. 

I.  Edmondson  Atkinson,  class  of  1865. 

John  Morris,  class  of  1826. 

Thomas  A.  Ashhy,  class  of  1873. 

L.  McLane  Tiffany,  class  of  1868. 

George  11.  Rohe,  class  of  1873. 

J.  Edwin  Michael,  class  of  is;;;. 

Samuel  Theobald,  class  of  1867. 

William  T.  Howard,  Professor  of  Gynecology. 

Eugene  F.  Cordell,  class  of  1868. 

Samuel    T.   F.'irlc,  Jr.,   1870. 

Hiram  W Is,  class  of  1882. 

Charles  O'Donovan,  class  of  1882. 
G.   Milton   Linthicum,  through   St.  John's 
College. 


The  Bulletin   wishes  him  success  and  many 
honors. 


Doctor  Preston  Hundley,  class  of  1909,  of  Bock- 
ley,  West  Virginia,  was  successful  before  the  West 
Virginia  Board  of  Medical  Examiners.  As  far 
as  I  could  find  out  Doctor  Hundley  was  the  only 
graduate  from  our  school  participating  in  the  ex- 
amination. 


Dr.  Samuel  Theobald,  class  of  1867,  has  been 
elected  president  of  the  American  ( )phthalmologi- 
cal  Society.  He  is  the  first  president  of  this  so- 
ciety from  the  South.  Dr.  Theobald  is  a  dis- 
tinguished oculist  in  this  city. 


Dr.  N.  W.  Hershnei",  class  of  1906,  recently 
moved  from  Stewartstown,  Pa.,  to  Mechanics- 
burg.     He  has  succeeded  well  in  his  profession. 


Dr.  R.  W.  Fisher,  former  assistant  Resident 
Physician  to  the  University  Hospital,  is  now 
practicing  his  profession  with  distinguished  suc- 
cess in  Morgantown,  W.  Va.  Dr.  Fisher  writes 
to  The  Bulletin  that  he  finds  The  Bulletin 
very  interesting  reading,  and  always  enjoys  read- 
ing the  same,  as  it  keeps  one  informed  as  to  the 
whereabouts  of  old  friends  and  classmates  and  of 
their  progress. 

Dr.  Fisher  has  recently  been  elected  President 
of  the  Monongalia  County  Medical  Association 
of  West  Virginia. 


Dr.  Fdvvard  V.  Copeland  of  Round  Hill, 
Ya.,  who  graduated  from  the  medical  department 
of  the  University  of  Maryland  in  1905,  sailed 
from  New  York  for  Europe  on  September  11,  and 
will  take  post-graduate  courses  in  London  and 
Vienna. 


Dr.  J.  Julius  Richardson,  class  of  1889,  of 
Washington,  D.  C,  is  accompanying  President 
Taft  upon  his  Western  trip  as  medical  adviser. 


Drs.  W.  J.  Blake  of  Benwood.  Simon  W.  Hill  of 
Switchback,  Preston  Hundley  of  Berkeley,  all  of 
the  class  of  1909,  have  successfully  passed  the 
Board  of  Medical  Examiners  of  West  Virginia. 


Drs.  11.  O.  Keik,  J.  X.  Reik.  W.  T.  Watson, 
J  S.  Fulton  and  T.  C.  Worthington  attended  the 
international  Congress  of  Medicine  at  Budapest. 


Dr.  John  S.  Fulton,  Professor  of  State  Medi- 
cine, has  been  appointed  executive  secretary  of 
the  International  Congress  on  Hygiene. 


Dr.  W.  II.  Houston  was  chairman  of  the 
Dorchester  Count}-  Republican  Convention,  held 
on  August  31,  1909. 

Among  the  delegates  to  the  recent  Republican 
State  Convention  were  Drs.  G.  T.  Simonson  of 
Somerset  county,  W.  H.  Houston  of  Dorchester 
county,  Luther  Kemp  and  S.  L.  Bare  of  Carroll 
oourltv,  and  H.  B.  Gantt  of  Anne  Arundel  county. 


Drs.  A.  L.  Wilkinson,  Josiah  S.  Bowc>i,  George 
II.  Hocking  and  R.  C.  Massenburg  delivered 
short  addresses  at  the  September  meeting  of  the 
Baltimore  County  Medical  Society,  held  in  the 
rooms  of  the  County  Board  of  Health. 


Dr.  W.  Cuthbert  Lyon,  class  of  1907,  of  For- 
rest Park,  Md.,  was  a  successful  candidate  at  the 
recent  examination  held  at  Fort  McHenry  for 
appointment  as  army  surgeon,  with  rank  of  first 
lieutenant  in  the  Medical  Reserve  Corps.  Dr. 
Lyon  is  a  native  of  Newburgh,  N.Y.,  and  a  gradu- 
ate of  the  medical  department  of  the  University 
of  Maryland.  Dr.  Lyon,  after  having  served  a 
year  as  interne  at  the  University  Hospital,  went 


i6o 


THE    H<  ISPITAL    BULLETIN 


abroad,  where  he  pursued  a  course  of  advance 
study  in  Germany.  The  Bulletik  extends  to 
Dr.  Lyon  its  warmest  congratulations  and  wishes 
him  much  success. 


Dr.  T.  B.  O wings,  class  of  1852,  the  president 
of  the  Howard  County  Medical  Society,  presided 
at  the  regular  September  monthly  meeting,  held 
at  Ellicott  City,  Md.,  September  6,  1909.  Dr. 
Owings  is  a  prominent  practitioner  of  Ellicott 
City  and  the  surrounding  country.  He  has  been 
engaged  in  the  practice  of  his  profession  for  more 
than  fifty-five  years,  and  is  one  of  the  best  known 
physicians  in  that  section  of  the  country.  Dr. 
Frank  O.  Miller,  class  of  1902,  and  John  W. 
Hebb,  Jr.,  class  of  1901,  also  attended  the 
meeting. 


Dr.  C.  D.  Marchant.  class  of  1897,  read  a  paper 
before  the  meeting  of  the  Tidewater  Medical 
Society,  held  in  Fredericksburg.  September  19, 
1909. 


Dr.  C.  W.  Vogel,  past  assistant  surgeon, 
United  States  Public  Health  and  Marine  Hospital 
Service,  was  granted  three  days'  leave  of  absence 
from  August  23,  1909,  under  paragraph  189, 
Service  Regulations. 


Dr.  A.  M.  Shipley  delivered  a.  lecture  to  the 
Caroline  Medical  Society  at  Denton.  September 
9,  1909,  on  "Abdominal  Diagnosis." 


Dr.  A.  D.  McConachie.  805  North  Charles 
street,  has  been  elected  professor  of  the  Diseases 
of  the  Ear,  Nose  and  Throat,  in  the  Maryland 
Medical  College.  Dr.  Josiah  S.  Bowen  has  been 
appointed  an  associate  to  the  chair  of  Diseases 
of  the  Ear,  Nose  and  Throat  in  the  Maryland 
Collesre. 


Dr.  VV.  S.  Love.  836  West  North  avenue,  has 
been  made  professor  of  Therapeutics  in  the 
Maryland  Medical  College. 


Dr.  Jose  Uirsh  was  in  charge  of  the  Hebrew 
Hospital  baby  camp,  which  has  been  closed  for 
the  winter. 

J.  Lee  McComas.  M.  D.,  one  of  the  oldest 
members  of  the  historic  McComas  family  and 
former  assistant  surgeon  in  the  United  States 
Army,  spent  September  12,  1900,  at  the  Eutaw 


House.  Dr.  McComas  was  born  in  Baltimore 
May  24,  1835.  His  family  is  closely  related  to 
Henry  McComas,  who  was  shot  and  killed  at  the 
Battle  of  North  Point. 

The  doctor  retired  from  active  practice  in  1902. 
when  he  fell  and  fractured  his  hip. 

Dr.  McComas  has  had  a  varied  career  since 
being  graduated  from  the  University  of  Maryland 
in  1858.  He  started  to  practice  medicine  at 
Berkeley  Springs,  W.  Ya.,  and  in  a  short  time 
went  to  Oakland,  Md.  For  many  years  he  has 
been  the  house  physician  at  Deer  Park  Hotel.  In 
1 861  he  was  appointed  an  assistant  Army  surgeon 
and  had  charge  of  the  Government  hospital  at 
Oakland. 

Dr.  McComas  was  the  attending  physician  at 
the  bedside  of  Jefferson  Davis  when  he  was  a 
United  States  Senator.  He  also  attended  Harri- 
son when  he  was  in  the  LTnited  States  Senate,  and 
is  the  proud  possessor  of  a  cup  and  saucer 
donated  to  him  by  Mrs.  Harrison,  with  the  name 
Caroline  H.  Harrison  engraved  on  it. 

Dr.  McComas  has  traveled  extensively,  and 
usually  resides  in  Mexico  in  the  winter.  He 
speaks  several  languages.  His  son.  Dr.  Henry 
W.  AlcComas,  of  Oakland,  took  up  his  father's 
practice  at  his  retirement.  For  many  years  Dr. 
McComas,  senior,  was  a  surgeon  of  the  Baltimore 
and  Ohio  Railroad. 


Since  returning  from  his  sojourn  at  Hot 
Springs,  Va.,  the  health  of  Dr.  Charles  A.  Wells, 
Democratic  candidate  for  the  State  Senate  from 
Prince  George's  county,  has  improved  to  such 
an  extent  that  all  doubt  concerning  his  acceptance 
of  the  nomination  has  been  removed.  Dr.  Wells 
said  he  would  accept  October  1.  at  which  time 
he  will  define  his  position  on  some  of  the  leading 
issues  of  the  campaign. 

When  seen  at  his  home  in  Hyattsville  Dr. 
Wells  said  he  proposed  to  prosecute  a  vigorous 
campaign  from  early  in  October  until  election 
day. 


Under  the  caption  of  Leading  Men  of  Maryland 
the  Star  has  this  to  say  concerning  Dr.  Frank 
Martin,  Clinical  Professor  of  Surgery,  University 
of  Maryland:  "Dr.  Martin  is  one  of  the  best 
known  practitioners  in  the  city,  and  stands  among 
the  prominent  medical  men  of  the  country.  He 
is  prominent  socially  and  is  a  member  of  the 
leading  clubs."     Above  the  preceding  inscription 


THE    HOSPITAL    BULLETIN 


161 


is  a  portrait  of  Dr.  Martin.  By  honoring  Dr. 
Martin  the  Star  confers  a  signal  honor  upon  the 
University  of  Maryland,  and  the  The  Bulletin 
is  glad  that  the  professors  of  our  institution  are 
held  in  such  high  repute  by  the  daily  papers  and 
the  people  at  large. 


Dr.  D.  C.  Absher  writes  Dr.  Randolph  Wins- 
low:  "I  am  enclosing  a  clipping  from  a  July  issue 
of  our  local  paper  and  it  will  tell  you  the  esteem 
in  which  the  University  of  Maryland  is  held  in 
this  part  of  the  country.  I  want  to  see  the  Uni- 
versity of  Maryland  prosper  and  become  a  real 
State  university,  and  a  great  one,  too,  and  I  hope 
that  some  day  I  may  be  able  to  help  it  do  so.  I 
am  assistant  in  a  small  hospital  here.  Xorth 
Wilkesboro,  X.  C.  The  notice  is  as  follows : 
"Dr.  D.  C.  Absher  was  in  town  this  week  and  has 
decided  to  locate  here  (North  Wilkesboro,  N.  C.) 
for  the  practice  of  medicine  and  will  return  next 
week.  Dr.  Absher  has  just  completed  a  thorough 
course  at  the  University  of  Maryland,  one  of  the 
highest  institutions  of  the  country,  and  received 
license  to  practice  from  the  State  Board  recently 
at  Asheville.  It  is  a  pleasure  to  have  Dr.  Absher 
locate  here,  which  is  his  old  home  town  and 
among  his  friends,  with  a  promising  future." 


Dr.  Julian  Mason  Gillespie,  class  of  1909,  of 
Virginia,  has  successfully  met  the  entrance 
requirements  of  the  Army  Medical  Examining 
Board,  and  has  been  ordered  to  report  at  the 
Army  Medical  School,  Washington,  for  instruc- 
tion. 


Dr.  W.  Cole  Davis,  class  of  1908,  formerly 
resident  physician  at  St.  Joseph's  Hospital,  Balti- 
more, has  successfully  passed  the  Army  Medical 
Examining  Board,  and  has  been  commissioned  a 
second  lieutenant  in  the  Medical  Corps,  United 
States  Army.  He  has  been  ordered  to  report  at 
the  Army  Medical  School,  Washington,  District 
of  Columbia. 


Dr.  Joseph  Gichner  is  being  congratulated  upon 
the  birth  of  a  brand-new  baby. 


Dr.  Felix  Jenkins,  class  of  1849,  84  years  of 
age,  one  of  our  oldest  alumni  and  for  more  than 
fifty  years  a  practitioner  of  medicine  in  Baltimore, 
is  seriously  ill  at  the  home  of  his  daughter,  Mrs. 
Thomas   W.    Offutt,    near    Towson,    Md.     Dr. 


Jenkins  is  one  of  the  oldest  living  representatives 
of  his  family.  He  fell  upon  the  pavement  on 
Cathedral  street  in  1907.  in  front  of  the  Cathedral, 
and  broke  his  hip.  Since  that  time  he  has  been 
in  failing"  health,  and  several  weeks  ago,  owing 
to  general  debility,  was  compelled  to  seek  his  bed. 
Small  chances  for  his  recovery  are  entertained. 
Dr.  Jenkins  retired  from  active  practice  about  six 
years  ago,  since  which  he  has  been  taking  life 
quietly. 


Dr.  Eitz  Randolph  Winslow,  class  of  1906,  has 
returned  from  Hinton,  Va.,  where  he  has  been 
engaged  for  the  past  nine  months  in  the  practice 
of  his  profession,  and  has  located  at  1900  Mt. 
Royal  Teirace,  his  former  residence. 


Dr.  and  Mrs.  Frank  Martin  have  returned  from 
a   tour  of   Europe.     They   were   abroad   several 

mi  mtlis. 


Dr.    William    T.    Watson,    of    Baltimore,    has 
returned  from  a  four  months'  trip  abroad. 


( )ur  alumni  took  a  prominent  part  in  the  trans- 
actions of  the  semi-annual  meeting  of  the  Medical 
and  Chirurgical  Faculty,  held  at  Braddock 
Heights  September  15,  16  and  17.  Dr.  Randolph 
Winslow  read  a  paper  entitled  "The  Surgery  of 
the  Thyroid  Gland"';  Dr.  X.  M.  Owensby,  "The 
Almshouse  Care  of  the  Insane,"  and  Dr.  J.  J. 
Carroll,  "Why  Does '  )pthalmia  Neonatorum  Con- 
tinue to  Cause  So  Much  Blindness?" 

Dr.  Nathan  Gorter,  class  of  1870.  made  .1 
report  on  the  Pure  Food  Act.  Dr.  T.  Clyde 
Routson,  class  of  1899,  president  of  the  Frederick 
County  Medical  Association,  with  a  few  well- 
chosen  words  welcomed  the  visitors  on  behalf  of 
his  local  society,  emphasizing  particularly  the 
honor  which  the  Frederick  Medical  Society 
esteemed  it  to  be  the  hosts  of  the  Faculty. 

Those  who  attended  the  semi-annual  meeting 
of  the  Medical  and  Chirurgical  Faculty: 

Baltimore — Drs.  C.  U.  Smith,  James  J.  Carroll, 
X.  M.  Owensby,  Herbert  Harlan,  Randolph 
Winslow,  Samuel  T.  Earle.  John  T.  King. 

Westminster — Drs.  Charles  R.  Foutz,  H.  M. 
Fitzhugh. 

Hagerstown — Drs.  E.  A.  Wareham,  J.  W. 
Humrickhouse,  W.  D.  Campbell,  E.  L.  Bowlus. 

Montgomery  County — Drs.  J.  E.  Deets,  W.  L. 
Lewis,  T.  E.  Darby,  E.  C.  Etchison. 


1 62 


THE    HOSPITAL    BULLETIN 


Crisfield — Dr.  J.  J.  Somers. 

Pikesville — Dr.  H.  Lewis  Naylor. 

Bryantown — Dr.  L.  C.  Carrico. 

Those  who  attended  were  treated  to  first-rate 
scientific  contributions.  The  social  side  of  the 
meeting  was  not  neglected,  there  being  several 
entertainments,  but  owing  to  the  unsettled 
weather  the  proposed  side  trip  to  Antietam  battle- 
field was  fores:one. 


Dr.  John  Evans  Mackall,  class  of  1908,  of 
Elkton,  Md.,  a  former  assistant  resident  gynecol- 
ogist at  the  University  Hospital,  has  received  an 
appointment  in  the  Rocky  Mount  Hospital,  N.  C  , 
of  the  Atlantic  Coast  Line  Railway. 


Dr.  Arthur  Ralph  Hunter,  class  of  1903,  of 
South  Carolina,  has  been  presented  by  his  wife, 
who  was  Miss  Martha  Cook,  a  former  pupil  nurse 
in  the  University  Hospital,  with  a  bouncing  boy. 
This  is  Dr.  and  Mrs.  Hunter's  second  child,  the 
first  also  being  a  boy. 


Dr.  James  M.  Craighill,  Clinical  Professor  of 
Medicine,  has  been  elected  chairman  of  the  Sec- 
tion on  Clinical  Medicine  and  Surgery,  Baltimore 
City  Medical  Society. 


DEATHS 


Dr.  Francis  Marion  Slemons,  class  of  i860, 
for  many  years  one  of  the  foremost  citizens  of 
Wicomico  county,  died  September  22,  1909,  at 
the  home  of  his  son,  Dr.  Morris  Slemons,  in  Bal- 
timore. Dr.  Slemons  has  been  for  49  years  a  prac- 
ticing physician  of  Salisbury,  Md.,  and  was  one 
of  the  leading  medical  men  in  his  section  of  the 
State.  He  was  loved  by  the  people  for  his  many 
fine  qualities,  and  he  will  be  missed  in  Salisbury 
as  perhaps  no  other  man  would.  Dr.  Slemons 
vas  born  at  Fruitland,  then  Forktown,  in  1839. 
The  house  in  which  this  event  occurred  is  still 
standing.  He  studied  medicine  in  the  medical 
department  of  the  University  of  Maryland,  and 
was  graduated  from  that  institution  in  i860. 
After  receiving  his  diploma,  he  practiced  medicine 
in  Fruitland  for  a  number  of  years,  then  removed 
to  Salisbury,  and  formed  a  partnership  witli  the 
hte  Dr.  Stephen  P.  Dennis. 

Since  early  summer  Dr.  Slemons  has  been  in 
tailing  health  ;  at  that  time  lie  was  stricken  with 


paralysis,  and  with  his  wife,  who  is  also  a  para- 
lytic,  was  taken  to  Baltimore,  June  t,  1909,  to  the 
home  of  his  son,  Dr.  Morris  Slemons.  a  graduate 
of  the  Johns  Hopkins  Medical  School. 

He  gradually  became  weaker  after  his  removal 
to  Baltimore,  and  died  without  ever  having  ral- 
lied. Dr.  Slemons  was  nominated  for  clerk  of 
the  Circuit  Court  by  the  Democrats  in  1885,  after 
tne  memorable  fight  in  the  convention  between 
the  late  Stephen  P.  Toadvine  and  Lafayette  Hum- 
phreys. He  was  not  a  candidate,  but  was  offered 
the  nomination  and  accepted.  He  was  elected,  and 
filled  the  office  creditably  for  six  years.  He  was 
at  the  time  of  his  death  president  of  the  Salisbury 
Building,  Loan  and  Banking  Association,  which 
organization  he  helped,  to  form  in  company  with 
the  late  William  B.  Tilghman  and  Ebenezer  L. 
Wailes.  Dr.  Slemons  was  a  ruling  elder  in  the 
Wicomico  Presbyterian  Church.  He  leaves  a 
widow  and  two  sons,  Dr.  Morris  Slemons  of  Bal- 
timore and  John  Slemons  of  New  York. 


Dr.  William  S.  Cockrell,  class  of  1879,  died  at 
his  home  near  Harper's  Ferry,  W.  Ya.,  August 
27,  1909,  in  the  66th  year  of  his  age. 

Dr.  Ernest  E.  Adelsburger,  class  of  1902,  30 
vears  of  age,  of  414  N.  Carrollton  avenue,  died 
Friday,  September  17,  1909,  at  his  home. 

Dr.  Adelsburger  was  a  graduate  of  the  Uni- 
versity of  Maryland,  class  of  1902,  and  has  been 
practicing  medicine  since  that  time  in  Baltimore. 
He  is  survived  bv  four  brothers  and  three  sisters. 


Dr.  James  A.  Shackelford,  class  of  1873,  of 
Greenville,  Miss.,  died  July  19,  1900,  at  Carroll- 
ton,  Miss. 


Dr.  Richard  B.  C.  Lamb,  class  of  1904,  of 
Yslita,  Texas,  died  in  the  Providence  Hospital, 
El  Paso,  Texas,  June  22,  1909,  of  typhoid  fever, 
ased  26. 


Dr.  John  Woolf  Burton,  class  of  1865,  com- 
mitted suicide  by  hanging  at  his  home  in  High 
Point,  N.  C,  June  30,  1909,  aged  65. 


Dr.  Byron  Clarke,  class  of  1 88 1,  died  at  Wash- 
ington, Pa.,  August  5,  1909,  of  diabetes,  aged  72. 
He  was  formerly  professor  of  X-ray  medicine  in 
the  New  York  Eclectic  Medical  College. 


THE  HOSPITAL  BULLETIN 

Published  Monthly  in  the  Interest  of  the  Medical  Department  of  the  University  of  Maryland 
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Contributions  invited  from  the  Alumni  of  the  University, 
Business  Address,  Baltimore,  Md. 


Entered  at  the  Baltimore  Post-office 
as  Second  Class  Matter 


Vol.    V 


BALTIMORE,  MD.,  NOVEMBER  15,   1909. 


No.  9 


BALTIMORE  AS  AN   EDUCATIONAL 

CENTER. 

By  T.  A.  Ashby,  M.D. 

The  Bostonians  claim  that  Boston  is  the  "hub 
of  the  universe"  and  the  "Athens  of  America." 
This  claim  is  based  upon  the  culture,  refinement 
and  high  standard  of  citizenship  of  the  people  of 
that  city.  However  just  the  claim  may  be,  it  is 
a  well-known  fact  that  Boston  stands  among  the 
leading  cities  of  this  country  as  a  leader  in  all 
educational  enterprises  and  civic  exploits.  As  a 
home  of  the  largest  and  most  richly  endowed 
university  in  this  country,  with  magnificent  hos- 
pitals and  charitable  institutions,  with  large  pub- 
lic and  private  libraries  and  art  galleries,  with 
enterprising  publishing  houses,  Boston  undoubt- 
edly possesses  every  establishment  for  the  pro- 
motion of  education  and  culture  among  her  peo- 
ple. Her  poets,  historians,  essayists,  scientists 
and  statesmen  have  taken  rank  among  the  leaders 
of  thought  and  investigation  in  America.  The 
people  of  Boston,  therefore,  have  a  right  to  take 
just  pride  in  the  high  standard  of  culture  which 
prevails  in  that  community.  When  we  consider 
the  means  by  which  these  results  have  been 
reached  it  will  be  found  that  the  people  of  Boston 
and  of  Massachusetts  have  been  most  liberal  in 
their  contribution  to  the  endowment  of  their  edu- 
cational institutions  and  to  the  promotion  of  the 
best  results  which  can  be  achieved  by  the  liberal 
expenditure  of  money  on  education,  charity,  art 
and  science. 

Harvard  University  is  a  lasting  monument  to 
the  liberality  of  the  people  of  Massachusetts, 
whilst  the  splendid  hospitals  and  charitable  insti- 
tutions in  Boston  bear  testimony  to  the  liberality 
of  that  city  and  State.  Two  factors  have  con- 
tributed to  the  claim  which  Boston  makes  as  the 
"Athens  of  America" — first,  her  liberal  expendi- 
ture of  money  upon  her  educational  institutions, 
and,  second,  the  industry,  talent  and  enterprise 
of  her  people  in  fostering  literary  and  scientific 
pursuit. 

Comparisons  are  usually  odious,  but  it  is  but 


just  in  making  claims  to  consider  conditions  and 
environments.  The  advantages  which  Boston 
possessed  in  the  past  may  be  traced  to  conditions 
rather  than  environments.  Certainly  her  location, 
climate  and  soil  are  not  equal  to  those  possessed 
by  other  communities.  Ller  poverty  in  this  di- 
rection has  no  doubt  acted  as  a  stimulus  in  pro- 
moting enterprises  which  have  had  less  encour- 
agement in  more  richly  favored  sections.  Athens 
was  only  a  small  Grecian  city,  yet  her  contribution 
to  art  and  literature  is  a  marvel  of  the  ancient 
world.  It  would  seem  that  the  genius  of  a  people 
has  reached  its  highest  state  of  development  under 
conditions  where  encouragement  has  been  given 
by  wealth  and  civic  pride. 

Institutions  of  learning  must  be  subsidized  by 
city,  State  or  private  benevolences,  as  they  are 
less  able  to  bear  the  struggle  of  poverty  of  all 
human  establishments.  To  reach  the  highest 
standard  of  excellence  and  the  largest  develop- 
ment in  research  and  instruction  the  best  teachers 
and  investigators  are  demanded,  and  all  facilities 
for  research  must  be  supplied.  Endowment  or 
subsidy  alone  can  give  the  equipment  needed  for 
the  highest  training  of  student  bodies.  The  cost 
of  education  is  constantly  increasing,  and  tuition 
fees  can  no  longer  meet  the  requirements  of  our 
best  educational  institutions.  The  city,  State  and 
private  aid  must  come  to  the  relief  of  the 
teacher  and  scientific  investigator  if  the  best 
results  are  to  be  reached.  This  has  been  the 
secret  of  Boston's  intellectual  and  educational 
supremacy.  The  people  have  liberally  showered 
their  wealth  upon  her  institutions  which  seek  to 
promote  education,  to  relieve  suffering  and  to 
elevate  the  standard  of  citizenship.  The  question 
now  arises,  Is  it  not  time  for  the  people  of  Balti- 
more to  arouse  to  the  importance  of  making  this 
city  the  greatest  educational  center  in  this  coun- 
try? The  location  of  this  city  in  close  proximity 
to  the  nation's  capital,  her  genial  climate,  the  so- 
cial and  liberal  character  of  her  people,  all  tend 
to  show  that  Baltimore  has  all  of  the  material 
advantages  of  a  great  center  of  learning.     She 


1 64 


TIE    HOSPITAL    BULLETIN 


has  educational  institutions  which,  if  properly 
encouraged,  would  provide  facilities  for  the  edu- 
cation of  the  largest  bodies  of  students  assembled 
from  all  sections  of  our  country  and  from  all 
parts  of  the  civilized  world.  As  far  as  can  be 
ascertained.  Baltimore  is  drawing  annually  to  her 
educational  institutions  some  2500  students  from 
wide  sections  of  this  country.  Of  this  number 
over  1500  are  drawn  by  our  medical  institutions. 
These  students  come  from  all  States  in  the  United 
States  and  from  many  foreign  countries.  Egypt, 
Assyria,  Japan.  China.  Cuba.  Porto  Rico,  .Mex- 
ico and  other  foreign  countries  are  represented 
<n  these  student  bodies. 

The  Johns  Hopkins  University,  with  its  splen- 
did record  along  the  lines  of  scientific  research, 
has  extended  the  fame  of  Baltimore  to  all  parts 
of  the  civilized  world.  This  institution  is  destined 
to  do  a  distinct  class  of  work  which  will  always 
reflect  credit  upon  our  city  as  the  home  of  inves- 
tigation and  of  intellectual  and  scientific  prog- 
ress. In  addition  to  the  Hopkins,  there  are  a 
number  of  schools  preparing  both  men  and 
women  for  the  practical  duties  of  life  in  all  the 
professions  and  avocations.  It  is  to  this  class  of 
institutions  that  the  hand  of  friendship  and  of 
plenty  should  be  extended  by  both  city  and  State, 
since  they  are  engaged  in  training  the  student 
along  lines  of  work  which  make  for  education, 
culture  and  the  highest  citizenship.  Education, 
in  its  broadest  sense,  is  the  preparation  of  the 
student  for  useful  work,  for  high  moral  standards 
and  for  civic  virtues.  These  are  the  qualities 
which  go  to  make  men.  and  these  are  the  men 
who  go  to  make  cities  and  States.  To  attract  the 
attention  of  the  outside  world  to  Baltimore  as  a 
center  of  education  her  institutions  should  be  lib- 
erally subsidized  and  encouraged.  They  all  need 
better  facilities  in  the  way  of  an  educational  plant 
providing  laboratories,  libraries  and  classrooms, 
better  pay  for  teachers  and  instructors. 

"With  an  upward  development  of  our  institu- 
tions it  is  believed  that  the  present  student  bodies 
nmv  assembled  in  these  various  institutions  could 
be  doubled  or  quadrupled  in  the  next  five  or  ten 
years.  In  other  words,  with  our  educational  in- 
stitutions thoroughly  organized  and  equipped  for 
all  classes  of  educational  work  of  the  highest 
standard  it  will  be  possible  to  draw  to  Baltimore 
a  student  body  of  some  10.000  students  from  all 
parts  of  the  world.  The  presence  of  such  a  large 
body  of  young  men  and  women  seeking  an  edu- 


cation would  have  a  material  and  moral  value  to 
this  community  which  cannot  be  estimated  in 
dollars  and  cents.  Such  a  body  of  students 
would  give  to  our  city  such  a  prestige  as  would 
soon  establish  for  her  the  claim  of  being  the 
"Athens  of  America."  Why  not  try  to  wrest 
from  Boston  her  honored  claim  as  a  leading  cen- 
ter of  learning  in  America  and  establish  that 
claim  for  our  own  city,  which  already  is  so  widely 
known  as  a  city  of  monuments,  as  a  home  of  art, 
of  culture  and  of  refinement?  It  is  not  too  op- 
timistic to  make  the  claim  that  what  has  been 
done  in  New  England  for  the  promotion  of  the 
best  interests  of  her  people  in  education,  charity 
and  citizenship  can  be  done  in  Maryland.  All  we 
need  here  is  liberality,  pride,  love  of  learning  and 
the  high  spirit  of  endeavor  which  has  charac- 
terized the  Xew  England  people. 

It  may  he  asked.  1  low  can  the  results  here  indi- 
cated be  reached  ?  The  answer  to  this  question 
will  suggest  both  conditions  and  environments. 
( irant  that  Baltimore  possesses  both  of  these  as- 
sets as  her  working  capital,  it  is  only  uecessary 
to  use  this  capital  in  a  productive  way.  Educa- 
tional institutions,  whilst,  strictly  speaking,  they 
are  not  commercial  enterprises,  are  so  dependent 
upon  administration  and  enterprise  that  success 
and  usefulness  only  follow  the  wise  use  of  these 
two  agencies.  An  institution  of  learning  must 
own  a  plant  suitably  adapted  to  all  of  its  purposes. 
Its  assembly-rooms,  halls,  laboratories  and 
grounds  must  conform  to  the  needs  of  its  student 
body.  Its  teachers,  instructors  and  demonstrators 
must  be  selected  with  due  respect  to  their  moral 
and  intellectual  equipment  for  the  training  of  the 
individual  student  and  of  the  student  body.  Both 
teacher  and  student  must  be  fired  with  zeal  and 
enthusiasm,  and  these  faculties  are  only  devel- 
oped by  co-operation. 

With  such  a  plant  and  equipment  any  institu- 
tion of  learning  will  grow,  no  matter  how  humble 
its  beginning.  A  student  body  will  follow  the 
law  of  gravitation.  It  will  always  seek  institu- 
tions of  learning  which  live  up  to  their  promises 
and  measure  up  to  requirements.  What  is  needed 
to  make  Baltimore  a  center  of  learning  is  for 
every  educational  institution  in  the  city  to  get 
busy,  go  after  the  student  and  give  him  in  train- 
ing an  equivalent  for  his  outlay  of  money  ami 
mental  work. 

Nothing  will  draw  students  to  our  city  faster 
and  in  larsjer  numbers  than  this  character  of  in- 


THE    HOSPITAL    BULLETIN 


16= 


tellectual  honesty  and  industry.  The  education 
of  the  student  must  be  considered  from  a  com- 
mercial as  well  as  from  an  ideal  standpoint.  The 
student  is  seeking  knowledge  primarily,  and  per- 
sonal comfort,  pleasure  and  sentiment  as  second- 
ary claims.  All  of  his  needs  enter  into  the  devel- 
opment and  training  of  his  mind  and  character. 
His  home  life  as  a  student,  his  associations,  his 
ties  and  his  personal  comforts  all  should  contrib- 
ute to  his  mental  growth  and  equipment.  They 
should  stimulate  his  pride  and  industry  and  en- 
large his  views  of  life  and  its  responsibilities,  as 
well  as  of  its  promises.  Those  institutions  which 
recognize  these  various  claims  of  its  student  body 
and  work  in  harmony  with  them  will  receive  full 
returns  for  the  services  rendered. 

The  life  of  a  student  in  a  large  city  is  beset 
with  embarrassments  and  temptations  which  must 
be  met  by  the  influence  of  the  school  over  the 
mind  of  the  student.  This  has  been  done  in 
larger  cities  than  Baltimore,  which,  perhaps, 
offers  more  ideal  conditions  as  a  center  of  educa- 
tion than  any  large  city  in  America. 

All  of  the  institutions  of  learning  in  Baltimore 
are,  with  one  or  two  exceptions,  self-sustaining. 
In  other  words,  they  are  dependent  upon  tuition 
fees  for  the  conduct  of  their  work. 

In  this  age  of  large  undertakings  and  of  stren- 
uous growth  endowment  seems  absolutely  neces- 
sary to  the  successful  work  of  institutions  which 
aim  to  attract  large  student  bodies  or  to  do  a  high 
order  of  work  in  advanced  culture  or  scientific 
research.  Without  endowment  an  institution 
cannot  rank  among  the  great  schools  of  the  coun- 
try. It  cannot  employ  high-salaried  teachers  or 
do  any  extended  work  in  research  or  original  in- 
vestigation. It  does  not  follow,  however,  that 
such  schools  cannot  do  a  useful  or  high  order  of 
work  in  lines  of  secondary  education.  Such 
schools  can  train  lawyers,  clergymen,  teachers, 
engineers  and  physicians  for  practical  and  suc- 
cessful work  in  their  respective  professions.  It 
will  be  recalled  that  less  than  40  years  ago  the 
men  who  are  now  the  leaders  of  thought  and 
action  in  this  country  were  almost  to  a  man  edu- 
cated in  schools  which  are  now  classed  as  sec- 
ondary and  which  today  are  giving  courses  of 
instruction  far  in  advance  of  that  time.  Sec- 
ondary schools  have  advanced  as  rapidly  as  the 
largely  endowed  universities.  They  will  continue 
to  hold  a  large  place  in  the  educational  curricu- 
lum.    To   rise  to  the   front  rank   endowment   is 


essential.  This  term  endowment  must  be  consid- 
ered in  a  relative  sense,  since  it  occupies  the  same 
relation  to  education  that  capital  does  to  rail- 
roads, manufacture  or  mercantile  pursuits.  The 
small  merchant  is  as  much  in  evidence  as  the 
department  store,  and  in  his  small  way  is  doing 
just  as  good  work.  The  college,  high  school  and 
private  school  have  just  as  distinct  a  place  in  edu- 
cation as  the  endowed  university.  They  are  just 
as  necessary  to  our  social  and  economic  life. 
They  have  as  high,  if  not  as  distinguished,  a  mis- 
sion in  the  educational  world,  and  should  stand 
for  all  that  is  best  in  training  mind  and  character 
for  private  and  civic  duty.  They  will  give  char- 
acter to  communities  quite  as  respectable  as  the 
larger  institution  if  conducted  on  principles  of 
correct  thinking  and  right  doing.  With  one  large 
university  liberally  endowed,  Baltimore  has  a 
large  number  of  schools  of  the  unendowed  class 
which  are  drawing  large  classes  of  students  to 
this  city.  These  schools  can  be  made  the  nucleus 
of  her  growth  as  a  center  of  education.  They 
possess  advantages  and  possibilities  which  can  be 
enlarge)  1  by  the  enterprise  and  broad  spirit  of 
their  governing  bodies.  They  have  already  done 
much  for  this  city,  which  is  only  an  indication  of 
the  larger  growth  of  their  student  bodies  under 
energetic  and  resolute  action.  In  this  determined 
purpose  of  drawing  larger  numbers  of  students 
to  this  city  these  schools  should  demand  and  re- 
ceive every  encouragement  and  aid  possible  from 
city,  State  and  private  liberality.  There  should 
be  no  hesitation  in  going  before  the  public  with 
the  claim  that  generous  aid  extended  to  education 
in  many  forms  and  for  recognized  purposes  is  the 
highest  test  of  civic  pride  and  culture.  The  edu- 
cational plant  of  a  community  is  of  greater  value 
to  that  community,  as  a  rule,  than  any  other 
agency,  not  excepting  a  well-conducted  press. 
When  the  wealth  and  intelligence  of  our  citizen- 
ship is  brought  to  realize  that  its  culture,  refine- 
ment and  happiness  is  more  largely  promoted 
through  the  various  educational  agencies  at  work 
in  their  community  than  through  its  mercantile, 
manufacturing  and  commercial  interests  it  will 
extend  both  financial  aid  and  moral  support  to 
these  agencies.  It  is,  therefore,  the  first  duty  of 
every  institution  of  learning  in  this  city  to  keep 
its  work  in  public  view,  to  stand  up  for  all  that  is 
best  in  our  civic  government,  and  to  seek  the  aid 
of  wealth  and  friendship  in  the  more  rapid 
growth  of  education  and  charity  in  our  city. 


1 66 


THE    HOSPITAL    BULLETIN 


THE  PROFESSORS  OF  SURGERY  IN  THE 
UNIVERSITY  OF  MARYLAND. 


By  Randolph  Winslow,  M.D., 
Professor  of  Surgery,  University  of  Maryland. 


No.  3. — Granville  Sharp  Pattison,  M.D. 

Prof.  Granville  Sharp  Pattison  was  born  near 
Glasgow,  Scotland,  probably  in  the  year  1792. 
He  is  supposed  to  have  received  his  medical  edu- 
cation at  the  University  of  Glasgow.  Early  in 
life  he  was  an  assistant  to  Prof.  Allan  Burns,  and 
succeeded  him  in  the  chair  of  anatomy,  physiol- 
ogy and  surgery  at  the  Andersonian  Institution 
of  Glasgow.  He  was  a  favorite  pupil  of  Profes- 
sor Burns,  and  fell  heir  to  his  anatomical  mu- 
seum, as  well  as  to  his  professorial  chair.  He 
came  to  America  in  the  summer  of  1819  and 
opened  an  anatomical  school  in  Philadelphia ;  but, 
failing  to  receive  an  appointment  in  the  Univer- 
sity of  Pennsylvania,  and  declining  the  chair  of 
anatomy  in  the  Transylvania  University  of  Ken- 
tucky, he  was  offered  the  chair  of  surgery  in  the 
University  of  Maryland  in  1820,  which  he  ac- 
cepted. He  was  at  that  time  28  years  of  age  and 
had  made  no  particular  reputation  as  a  surgeon ; 
indeed,  his  predilections  were  for  anatomy  rather 
than  for  surgery,  and,  except  for  the  brief  period 
in  which  he  remained  in  the  University  of  Mary- 
land as  professor  of  surgery,  his  energies  during 
the  whole  of  his  life  were  directed  to  the  study 
and  teaching  of  anatomy.  He  was  a  handsome 
young  man,  of  a  somewhat  gay  and  restless  dis- 
position, and  of  a  contentious  and  quarrelsome 
nature.  He  remained  in  the  chair  of  surgery  in 
the  University  of  Maryland  until  1826,  when, 
owing  to  dissensions  in  the  faculty  and  to  the  fact 
that  the  Legislature  had  repealed  the  charter  of 
the  university  and  had  placed  the  government  in 
the  hands  of  a  board  of  trustees  instead  of  in  the 
board  of  regents,  in  which  it  was  originally  vested, 
he  resigned  his  chair  and  returned  to  London, 
where  he  was  made  professor  of  anatomy  in  the 
University  of  London.  During  his  connection 
with  the  University  of  Maryland  he  made  no 
great  reputation  as  a  surgeon,  but  is  said  to  have 
exercised  great  influence  in  the  faculty,  and  it  is 
thought  that  the  increase  and  prosperity  of  the 
medical  school  during  that  period  was  largely  due 
to  his  energy  and  counsel.  He  brought  with  him 
from  Scotland  the  museum  of  his  master,  Allan 
Burns,  which  he  induced  the  university  to  pur- 


chase at  a  cost  of  $Sooo.  This  collection  of  ana- 
tomical and  pathological  specimens  was  one  of 
the  richest  and  most  extensive  in  the  United 
States  at  that  time,  and  for  many  years  continued 
to  be  the  greatest  attraction  of  the  medical  school. 
It  was  said  to  have  numbered  1000  specimens, 
and  even  to  this  day  some  of  the  most  valued  and 
valuable  attractions  of  the  anatomical  department 
were  originally  a  portion  of  this  collection.  So 
valuable  and  so  highly  esteemed  was  this  museum 
that  a  special  building  was  erected  for  its  hous- 
ing, which  became  known  subsequently  as  Prac- 
tice Hall,  but  after  various  mutations,  alterations 
and  rebuilding  is  now  the  Gray  Laboratory  Build- 
ing. Dr.  Pattison  returned  to  America  in  1832, 
and  was  elected  professor  of  anatomy  in  Jeffer- 
son Medical  College  in  Philadelphia,  which  posi- 
tion he  continued  to  fill  until  1841,  when  he  be- 
came professor  of  general  descriptive  and  surgi- 
cal anatomy  in  the  recently  founded  medical  de- 
partment of  the  University  of  New  York.  He 
continued  to  occupy  this  chair  until  his  death  on 
November  12,  1851,  after  a  short  illness  from 
obstruction  of  the  common  bile  duct. 

Professor  Pattison  was  the  author  of  the  "Reg- 
ister and  Library  of  Medical  and  Chirurgical 
Science."  He  edited,  with  notes,  "Burns  011  the 
Surgical  Anatomy  of  the  Arteries  of  the  Head 
and  Neck,"  Masse's  "Anatomical  Atlas"  and  Cru- 
veilhier's  "Anatomy."  He  was  one  of  the  editors 
of  the  American  Medical  Recorder,  and  wrote  a 
number  of  articles  in  the  periodicals.  He  received 
the  honorary  degree  of  doctor  of  medicine  late  in 
life,  and  was  held  in  high  esteem  as  a  teacher  and 
lecturer  in  this  country.  He  became  involved  in 
a  controversy  with  Prof.  Nathaniel  Chapman  of 
the  University  of  Pennsylvania,  which  culminated 
in  his  sending  to  Dr.  Chapman  a  challenge  for  a 
duel,  which,  however.  Professor  Chapman  de- 
clined to  accept,  and  in  consequence  of  which  dis- 
pute a  hostile  meeting  was  arranged  some  years 
later  between  Gen.  Thomas  Cadwallader  of  Phil- 
adelphia, who  was  Chapman's  brother-in-law, 
and  Professor  Pattison.  The  duel  took  place  in 
Delaware,  and  Cadwallader  was  severely 
wounded,  the  bullet  entering  his  pistol  arm  near 
the  wrist  and  lodging  in  the  ulna,  where  it  re- 
mained throughout  his  life,  causing  serious  disa- 
bility and  impairment  of  health.  Pattison  es- 
caped without  injury  by  a  narrow  margin,  as  the 
bullet  passed  through  the  skirt  of  his  coat  near 
the  waist. 


THE    HOSPITAL    BULLETIN 


167 


REPORT  OF  A  CASE  OF  CYST  OF  BRAIX. 


By  F.  Rankin,  M.D., 
Resident  Surgeon  University  Hospital. 

Owing  to  the  comparative  rarity  of  the  condi- 
tion and  difficulty  of  diagnosis,  perhaps  a  report 
of  a  case  of  cyst  of  the  brain  found  in  the  left 
frontal  lobe  may  be  of  interest. 

A.  P..  white  male,  age  22  years,  lawyer  by  pro- 
fession, enters  hospital  July  30.  Patient  com- 
plains of  a  chain  of  symptoms  extending  over  a 
period  of  three  years,  but  which  within  the  last 
six  months  have  become  so  much  more  marked 
as  not  only  to  be  noticeable  to  his  associates,  but 
to  interfere  with  his  work. 

Motor  aphasia,  the  most  marked  and  distress- 
ing symptom  of  which  he  complains,  has  been  a 
source  of  trouble  only  within  the  last  half  year, 
but  during  this  time  the  patient's  family  have 
been  aware  of  a  decided  change  in  the  man's  dis- 
position and  habits,  he  having  apparently  lost  in- 
terest in  things  that  formerly  were  his  greatest 
pleasures  and  becoming  gradually  less  energetic 
recently,  showing  no  desire  to  do  anything  re- 
quiring any  exertion,  and  more  and  more  listless 
and  inactive. 

One  distinctive  feature  of  his  condition,  how- 
ever, is  the  fact  that  he  is  never  irritable  nor  has 
been  known  to  complain. 

At  irregular  intervals  patient  has  suffered  from 
violent  headaches,  the  pain  of  which  was  diffuse 
over  entire  head,  with  no  tendency  to  localize  in 
any  one  place.  The  attacks  were  not  accom- 
panied by  nausea  or  vomiting,  but  were  occasion- 
ally preceded  by  any  attack  of  vertigo.  An  ex- 
amination of  the  eyes  by  an  expert  revealed  no 
evidence  of  "choked  disc.'' 

PHYSICAL    EXAMINATION. 

Patient  is  small  man,  weighing  135  pounds  and 
standing  5  feet  5  inches  in  height.  Denies  any 
loss  of  weight.  Is  well  developed ;  muscle  good  ; 
skin  elastic  ;  fair  amount  of  subcutaneous  fat. 

Expression  :    Dull,  listless,  indifferent. 

Eyes :  Right  pupil  larger  than  left ;  reacts  to 
light  and  accommodation,  but  rather  sluggishly. 
Left  pupil  normal.  Vision  good  in  both.  No 
"choked  disc.'' 

Ears :    Low  set. 

Teeth  :    In  excellent  condition. 

Palate :    Arch  normal. 


Neck :  No  pulsations  or  glandular  enlarge- 
ment made  out. 

Thorax  :    Heart  and  lungs  negative. 

Cranial  Nerves :    Normal. 

.Motor  Power :    Normal. 

Sensation :  Normal,  no  areas  of  anesthesia  or 
hyperesthesia  being  found  over  entire  body. 

Co-ordination :    Good. 

Patella  Reflex :  Exaggerated  on  both  sides, 
slightly  more  so  on  right  than  on  left. 

Babinslci :    Present  on  right  side. 

Gordon  Reflex:    Present  on  right  side. 

Tendo  Achilles  Reflex :  Slightly  exaggerated 
on  both  sides,  more  so  on  right  than  on  left. 

Ankle  Clonus:    Present  on  both  sides. 

Abdominal  Reflexes :    Normal. 

Mentality:    Good. 

Appetite :    Good. 

Bowels  move  regularly  once  a  day. 

No  urinary  or  gastrointestinal  symptoms. 

Urinary  Analysis :  Color,  straw  :  reactions,  al- 
kaline :  sugar,  negative  ;  albumin,  negative ;  spe- 
cific gravity,  1015:  sediment,  scant:  triple  phos- 
phates, amorphous  phosphates,  occasional  hya- 
line cast,  few  leucocytes  and  epithelial  cells. 

BLOOD. 

Leucocyte  Count :    14,000. 

Red-Cell  Count:    6,488,000. 

Hby.  Count :    100  per  cent. 

Temperature:    980. 

Pulse:  68:  full,  strong,  good  volume  and  ten- 
sion ;  equal  on  both  sides. 

Family  History :    Negative. 

Past  History :  At  age  of  eight  years  patient 
suffered  from  an  attack  of  acute  articular  rheu- 
matism, which  was  recovered  from  in  short  time 
and  was  followed  by  110  sequelae.  Two  years 
later,  however,  he  developed  Eydenhaur's  chorea, 
which  persisted  for  about  six  months  and  then 
cleared  up,  leaving  the  patient  in  good  condition 
and  without  complications. 

Specific  History :  Admits  to  gonorrhea  six 
years  ago,  but  since  has  felt  no  ill-effects.  Nega- 
tive to  syphilis. 

Habits :  For  past  eight  years  patient  has  been 
a  hard  drinker  and  has  lived  a  more  or  less  disso- 
lute life.  Recently  he  claims  to  have  given  up  the 
use  of  alcohol  in  any  form.  Is  also  an  inveterate 
user  of  tobacco,  using  it  mostly  in  cigarette  form. 
Does  not  use  coffee  or  tea. 

Diagnosis :    After  careful  examination  of  the 


[68 


THE    HOSPITAL    BULLETIN 


patient,  as  set  forth  above,  the  diagnosis  of  intra- 
cranial growth  of  the  left  frontal  lobe  was  made 
for  the  following  reasons :  The  gradual  change 
of  character ;  the  presence  of  speech  disturbances 
and  the  presence  of  irregular,  periodic,  mo- 
mentary attacks  of  unconsciousness  ;  the  tripillary 
quality :  the  irregular,  violent  attacks  of  head- 
ache ;  the  more  marked  increase  of  the  deep  re- 
flexes on  the  right  side;  Babinski  and  Gordon 
reflexes  on  the  right  side,  with  their  absence  on 
the  left,  and  the  general  appearance  of  the  pa- 
tient. 

Having  decided  upon  the  diagnosis  of  intra- 
cranial growth,  a  craniotomy  was  advised,  ac- 
cepted, and  the  operation  performed  August  5. 

Operation :    Craniotomy. 

Operator :    Dr.  Shipley. 

Assistant :    Dr.  Rankin. 

Anesthetist :    Dr.  Broadwater. 

Anesthetic  :    Ether,  drop  method. 

The  head  having  been  prepared  in  the  usual 
manner  for  an  aseptic  operation,  a  curved  in- 
cision about  six  inches  in  length  and  having  its 
concavity  downward  was  made  over  temporal 
fossa  on  left  side,  the  incision  beginning  an  inch 
behind  external  angle  of  left  eye  and  ending  di- 
rectly over  ear.  Having  cut  through  and  dis- 
sected away  the  fascial  and  tissues  covering  the 
temporal  muscle,  the  fibers  of  this  muscle  were 
exposed  and  separated,  the  periosteum  of  the 
skull  raised  and  the  skull  trephined  with  the  Hud- 
son trephine. 

Immediately  upon  the  removal  of  a  button  of 
bone  the  brain  was  found  to  be  under  great  ten- 
sion, the  dura  bulging  perceptibly  and  the  pulsa- 
tion being  more  indistinct  than  normal.  The  dura 
was  incised,  and  the  brain  found  to  be  anemic, 
slightly  edematous  in  appearance,  but  pulsating. 
The  second  left  frontal  convolution  was  punc- 
tured, and  about  2  ounces  of  a  clear  fluid  flowed 
out  of  the  opening.  A  definite  cavity  and  wall 
could  be  made  out  by  introducing  a  probe  into  the 
punctured  convolution.  Llaving  drained  out  all 
the  fluid  and  stopped  a  rather  troublesome  oozing 
from  the  bone  with  Horsley's  wax,  the  dura  was 
closed,  as  were  the  other  layers,  muscle,  fascia 
and  skin,  in  order  in  usual  manner. 

Patient  recovered  from  the  operation  with  very 
little  reaction,  and  on  the  fifth  day  was  allowed 
to  be  up  in  rolling  chair.  On  eighth  day  stitches 
were  removed,  and  wound  found  to  have  healed 


by  primary  intention,  approximations  being  ex- 
cellent and  scar  only  slightly  noticeable. 

The  operation  having  been  subtemporal,  and 
the  fibers  of  the  muscles  separated  and  not  cut, 
there  was  no  depression. 

On  fifteenth  day  patient's  symptoms  had  cleared 
up  remarkably,  and  he  feels  entirely  well. 

Examination :  Expression  good.  Gordon  re- 
flex present  on  both  sides,  Babinski  absent  on 
right  side. 

Patella  Reflex :  Slightly  exaggerated  on  both 
sides. 

Abdominal  Reflexes :    Normal. 

Co-ordination :    Good. 

Sensation :    Normal. 

Cranial  Nerves :   Normal. 

Eyes :  Pupils  equal  and  react  normally  to 
sight  and  accommodation. 

Motor  aphasia  has  cleared  up  entirely. 

Patient  discharged  in  greatly  improved  condi- 
tion and,  in  his  own  words,  "feeling  like  a  dif- 
ferent man." 


THE  USE  OF  IODINE  AS  AN  ANTISEP- 
TIC   IN    SURGICAL    AND    GYNE- 
COLOGICAL  PRACTICE. 


By  I.  S.  Stone,  M.D.,  Washington,  D.  C. 

For  some  years  past  (January,  1872)  we  have 
been  using  solutions  of  iodine  in  our  gynecologi- 
cal work  and  to  the  exclusion  of  nearly  all  other 
so-called  antiseptics.  Iodine  may  be  relied  upon 
as  an  antiseptic,  disinfectant  and  deodorizer  in 
every  variety  of  gynecological  work.  That  is  to 
say.  it  will  accomplish  anything  expected  of  the 
other  agents  of  this  class  without  the  evil,  toxic 
or  undesirable  results  often  observed  when  anti- 
septics are  used.  In  the  hospital  where  the 
greater  part  of  my  surgical  work  is  done  the  odor 
of  iodoform  is  rarely  observed,  my  colleague  and 
I  having  voluntarily  relinquished  its  use  many 
years  since,  at  about  the  same  time,  but  inde- 
pendently of  each  other.  Since  then  we  notice 
the  use  of  iodoform  only  when  some  younger 
surgeon  thinks  it  necessary.  My  vaginal  hys- 
terectomies, or  Wertheim  operations,  all  recover 
without  iodoform  as  well  as  they  ever  did  with  it. 
In  fact,  we  can  conceive  of  no  necessity  for  any 
antiseptic  upon  gauze  in  clean  abdominal  or  vagi- 
nal work.  There  are,  however,  occasions  when 
there  is  need  for  thorough  cleansing  of  the  uterus. 


THE    HOSPITAL    BULLETIN 


169 


or  possibly  an  abscess  cavity  where  one  wishes  to 
add  an  antiseptic  to  the  gauze  pack  or  drain.  It 
is  in  such  cases  that  iodine  is  quite  as  satisfac- 
tory as  any  other  agent.  It  is  nearly  non-toxic 
and  rivals  permanganate  of  potash  in  its  antisep- 
tic qualities.  Our  constant  use  of  iodine  as  an 
antiseptic  dates  from  the  time  of  Senn's  adoption 
of  the  Claudius  method  of  sterilizing  catgut.  We 
think  this  catgut  has  been  found  as  germ-free  as 
any  other,  and  hence  our  adoption  of  the  drug  as 
a  bactericide.  Iodine  has  been  found  capable 
of  better  penetration  of  catgut  than  any  other 
chemical  agent.  This  fact  should  favor  its  use  in 
many  instances  where  there  is  a  demand  for  an 
agent  which  will  penetrate  into  the  tissues  with- 
out destructive  action. 

The  agents  which  are  in  constant  use  in  our 
hospitals,  such  as  hydrogen  peroxide,  mercuric 
bichloride  and  acid  carbolic,  have  a  destructive 
action  upon  healthy  tissues,  and  wound  healing  is 
retarded  by  their  use.  Besides  their  toxic  effect, 
they  coagulate  albumen  and  produce  a  necrosis 
which  must  be  removed  or  repaired  before  such 
wounds  can  unite.  We  therefore  use  and  recom- 
mend the  use  of  iodine  solutions  somewhat  as 
follows : 

1.  In  the  vagina  and  uterine  cavity  for  acute 
vaginitis  and  endometritis,  or  when  we  believe 

tthe  mucosa  invaded  by  infection  without  ocular 
evidence  of  inflammatory  changes. 

2.  When  the  uterus  requires  curettement  for 
any  purpose  whatever,  as  for  missed  abortion, 
small  fibroid  or  mucous  polypi,  or  in  sapremia,  or 
hemorrhagic  endometritis.  The  gauze  packing  is 
saturated  with  the  iodine  solution  just  prior  to 
its  use. 

3.  To  any  stump  left  in  the  abdomen  con- 
nected with  the  vagina,  uterus  or  bowel,  such  as 
occurs  after  supravaginal  hysterectomy,  or  ap- 
pendectomy, excision  of  diverticula;,  etc.,  where 
carbolic  acid  or  similar  agents  have  formerly 
been  used.  We  now  apply  iodine  (25  per  cent.) 
to  the  cervix  and  portio  before  hysterectomy  for 
tumor.  This  usually  leaves  a  sterile  area  through 
which  the  uterus  is  amputated. 

4.  In  any  abscess  cavity  if  gauze  is  needed,  as 
in  mammary  abscess  or  in  case  of  hemorrhage 
after  incision  requiring  gauze  packing. 

5.  On  the  abdomen  or  upon  any  skin  surface 
5  to  10  minutes  before  making  the  incision. 

Recently  we  read  in  a  German  medical  journal 
that  a  surgeon  was  relying  upon  this  method  to 


the  exclusion  of  all  other  sterilization  of  the  skin, 
including  the  preliminary  scrubbing  with  soap 
and  water.  We  follow  the  method  outlined  be- 
low mainly  in  a  class  of  cases  requiring  prompt, 
quick  -work  without  prolonged  anesthesia.  The 
patient  is  as  carefully  prepared  in  her  room  and 
bed  as  may  be  done  by  the  ward  nurse.  This  in- 
cludes plenty  of  green  soap  and  water  and  gauze 
scrubbing.  A  towel  is  pinned  around  the  patient 
to  prevent  contact  with  hands,  clothes,  etc.  After 
arriving  in  the  anesthesia-room  the  abdomen  is 
painted  with  25  per  cent,  iodine  tincture.  U.  S.  P., 
or  equivalent  of  compound  tincture.  The  paint- 
ing is  usually  done  before  the  patient  takes  the 
anesthetic,  as  this  leaves  nothing  to  be  done  but 
catheterization  (if  required)  before  placing  the 
patient  upon  the  operating  table.  The  usual  ex- 
posure of  the  abdomen  and  wetting  of  the  frail 
patient  is  to  be  avoided  if  one  can  do  so  without 
danger  of  infection.  We  believe  iodine  is  capable 
of  sterilizing  the  skin  as  well  or  even  better  than 
any  other  chemical  agent,  and  it  enables  us  to  add 
this  important  matter  of  technique,  namely,  the 
dry  skin  instead  of  a  wet  one,  the  desirability  of 
which  should  be  apparent  to  everyone.  As  I 
write  this  I  have  received  a  letter  from  a  friend 
in  Mount  Sinai  Hospital  in  New  York  describing 
practically  the  same  method  as  the  above.  At 
that  hospital  the  iodine  is  applied  the  night  before 
operation,  and  a  second  application  is  made  when 
the  patient  is  placed  upon  the  operating  table. 
Stoneleigh  Court.  Washington.  D.  C. 


THE  ETIOLOGY  OF  PERITONITIS. 


By  F.  P.  Firer, 
Senior  Medical  Student,  University  of  Maryland. 

In  considering  the  etiology  of  peritonitis,  bac- 
teria and  their  products  are  of  paramount  impor- 
tance, and  the  sources  of  infection  come,  almost 
without  exception,  from  the  outside,  either 
through  the  walls  of  the  cavity  or  some  one  of 
the  intra-  or  extra-abdominal  viscera. 

Rare  affections,  as  found  secondary  to  acute 
rheumatism  of  joints  and  nephritis,  are  probably 
hematogenous  inflammation  of  the  appendix,  and 
bile  passages,  ulcerations  and  perforations  of  the 
gastrointestinal  tract,  infection  through  the  Fal- 
lopian tubes,  thrombosis  of  any  portion  of  the  in- 
testinal tract  secondary  to  mechanical  disturb- 
ances, rupture  of  abscesses  of  anyr  of  the  organs 


I/O 


THE    HOSPITAL   BULLETIN 


in  relation  to  the  peritoneum  are  among  the  usual 
sources  of  peritonitis.  The  so-called  aseptic  peri- 
tonitis caused  hy  foreign  bodies,  sponge  ligatures, 
hemorrhage  due  to  trauma,  ectopic  gestation, 
outpour  of  fluid  from  a  ruptured  gall-bladder, 
kidney,  cysts  of  various  forms  is  most  liable  to 
become  septic  by  invasion  of  bacteria. 

The  subperitoneal  tissue  is  richly  supplied  with 
lymphatics  and  blood  vessels,  giving  rise  to  the 
hemotogenous  variety  of  peritonitis,  the  usual 
form  being  secondary  to  pneumonia,  tuberculosis 
and  puerperal  invasion.  Tuberculosis  of  the  peri- 
toneum is-  seldom  primary,  usually  resulting  from 
some  distant  foci,  as  tuberculosis  of  the  mesen- 
teric or  retroperitoneal  glands,  tubes  and  ovaries. 

Pseudo-tuberculous  peritonitis  may  be  pro- 
duced by  bacteria,  fungi  of  different  forms,  small 
bits  of  foreign  bodies,  animal  parasites,  etc.  Per- 
forative peritonitis  is  the  most  important  and  is 
a  true  polyinfection,  as  many  as  10  different  spe- 
cies of  bacteria  having  been  found.  The  bacteria 
most  commonly  found  in  peritonitis  is  the  colon 
bacillus,  but  the  streptococcus  and  staphylococcus 
are  the  usual  forms  producing  this  condition,  as 
will  be  explained  later.  The  pneumococcus,  ty- 
phoid bacillus,  gonococcus  are  among  the  most 
common.  Bacillus  pyocyaneous  is  occasionally 
found.  As  predisposing  factors  may  be  men- 
tioned sudden  changes  of  temperature,  suppres- 
sion of  long-standing  discharges,  malignant  tu- 
mors, cachexia,  long  persisting  pain  and  discom- 
fort, secondary  mental  and  nervous  phenomena 
or  any  condition  having  a  tendency  to  lower  re- 
sistance. 

The  acute  and  chronic  forms  of  peritonitis  are 
to  be  differentiated,  which  may  be  general  or 
localized.  The  acute  localized  peritonitis  is  seen 
in  cases  in  which  bacteria  escapes  gradually  and 
in  small  numbers  through  the  walls  of  the  viscera 
or  in  which  perforation  takes  place  after  the  pro- 
duction of  some  exudate,  which  serves  the  pur- 
pose of  limiting  the  extension  of  the  infection. 
This  form  may  often  be  seen  associated  with  dis- 
eases of  the  tubes  or  uterus  and  in  the  region  of 
the  appendix.  Acute  general  peritonitis  may  be 
the  immediate  result  of  the  discharge  of  a  large 
quantity  of  infective  matter  from  a  perforated 
bowel  or  other  organ,  or  occur  secondarily  to 
localized  peritonitis  when  the  lining  wall  of  exu- 
dation is  broken  down. 

The  most  violent  forms  of  peritonitis  may  as- 


sume a  putrid  character  and  the  tissues  rapidly 
undergo  necrosis. 

Chronic  peritonitis  may  be  the  termination  of 
an  acute  attack  or  be  chronic  from  the  beginning. 
It  may  result  from  chronic  inflammation  or  a 
thickening  extending  from  adjunct  organs.  Thus 
in  cirrhosis  of  the  liver  the  peritoneum  covering 
the  spleen  may  be  involved  in  consequence  of  the 
chronic  congestion  or  inflammation  of  this  organ. 
Disease  of  the  appendix,  uterus,  tubes  or  ovaries 
may  be  associated  with  this  form  of  peritonitis. 

Chronic  peritonitis  may  result  in  replacement 
of  the  peritoneum  by  connective  tissue,  which 
mats  all  the  viscera  together.  Peritonitis  may 
result  from  undetermined  causes,  as  from  syph- 
ilis, gonorrhea,  rheumatism.  There  must  be  some 
injury  to  the  delicate  endothelial  cells  lining  the 
peritoneum  before  peritonitis  will  take  place. 
Among  the  conditions  not  previously  mentioned 
may  be  added  the  action  of  chemicals,  such  as 
mercuric  chloride  injections,  drying  or  chilling 
of  the  peritoneal  surface,  excessive  handling  of 
the  intestines,  constant  use  of  stimulating  fluids, 
dysentery,  strangulated  hernia  or  anything  pro- 
ducing intestinal  obstruction,  stab  wounds  and 
other  conditions  too  many  to  be  enumerated. 

The  following  experiment  tends  to  prove  that 
peritonitis  must  be  produced  by  some  injury  to 
the  delicate  endothelial  cells  lining  the  perito- 
neum : 

The  injection  of  a  moderate  amount  of  a  cloudy 
culture  of  bacteria  into  the  peritoneal  cavity  pro- 
duces no  peritonitis,  neither  does  the  injection  of 
bacteria  and  their  toxins,  as  both  are  rapidly  ab- 
sorbed by  the  healthy  peritoneum.  Feces  are  es- 
pecially dangerous  because  the  foreign  particles 
irritate  the  peritoneal  membrane.  They  also  con- 
tain the  bacteria,  so  that  the  injured  area  pro- 
tects them  from  rapid  absorption.  When  an 
abscess  ruptures  into  the  peritoneal  cavity  it  car- 
ries in  the  discharged  pus  all  of  the  necessary 
elements  for  a  spreading  infection.  The  bacteria 
and  toxins  which  are  hidden  in  the  particles  of 
fibrin  and  necrotic  tissue,  which  acts  as  an  irri- 
tant as  well  as  to  harbor  the  bacteria  until  an  in- 
flammation can  be  started  in  the,  as  yet,  unin- 
jured peritoneum.  Trauma  during  the  course  of 
an  operation  and  the  simple  presence  of  bacteria 
will  start  an  active  process,  and  foreign  particles 
are  not  necessary  to  start  an  inflammation. 

The  discovery  of  colon  bacillus  in  the  perito- 
neal fluid  a  few  hours  before  or  after  the  death 


THE    HOSPITAL    BULLETIN 


I7X 


of  a  patient  cannot  be  assumed  as  ai.  absolute 
evidence  concerning  the  infective  organism,  as 
one  instance  is  recorded  in  which  one  hour  after 
death,  due  to  peritonitis  as  a  terminal  infection 
of  cirrhosis  of  the  liver,  a  small  quantity  of  the 
exudate  was  withdrawn  by  means  of  a  sterile 
syringe  and  found  to  contain  a  pure  culture  of 
pneumococcus.  Twenty-six  hours  after  death 
the  cultures  obtained  from  the  purulent  exudate 
showed  only  the  presence  of  vast  numbers  of 
colon  bacillus.  Hence  the  difficulty  encountered 
in  the  isolation  of  a  feebly  growing  pathogenic 
germ  in  the  presence  of  a  more  vigorous  sapro- 
phyte. 

In  appendicitis  the  organ  may  be  surrounded 
by  a  pus  sac  containing  nothing  but  colon  bacil- 
lus, but  its  wall  upon  section,  and  properly 
stained,  will  show  throughout  its  whole  thickness 
streptococci. 


EXCESSIVE  DIARRHEA  IN  TYPHOID- 
ITS   CONTROL. 


By  Nathan  Winslow,  M.D. 

Different  authorities  and  different  teachers 
have  various  views  upon  this  most  perplexing 
question.  Some  advise,  if  the  stools  number  no 
more  than  ten  or  a  dozen,  to  adopt  no  measures 
for  their  control,  whilst  others  suggest  the  use  of 
chalk  mixture,  opium,  bismuth,  etc. ;  again,  still 
others  recommend  purgation  with  calomel  and 
salts  in  obstinate  diarrhea.  It  has  been  my  cus- 
tom to  keep  hands  off  in  the  dysenteries  of  ty- 
phoid, but  having  recently  a  case  with  peristent, 
annoying  diarrhea,  I  spoke  to  my  friend.  Dr.  Wil- 
liam 1.  Messick,  and  asked  him  his  experience 
with  the  diarrheas  of  typhoid.  Much  to  my  sur- 
prise, he  replied  that  in  an  experience  of  more 
than  14  years  he  had  never  had  a  case  of  typhoid 
with  frequent  fecal  movements.  L^pon  recogniz- 
ing that  he  was  dealing  with  typhoid  fever,  with 
a  tendency  to  frequent  alvine  evacuations,  he 
placed  his  patient  upon  resorcin,  grains  5,  every 
four  hours,  and  in  a  very  few  days  the  patient 
was  constipated.  So.  heeding  his  advice,  I  re- 
sorted to  his  method  of  treatment,  and  within  a 
few  days  the  movements  were  reduced  from  10 
to  12  in  a  clay  to  one  or  two.  with  a  great  deal  of 
relief  to  the  patient  both  in  energy  and  mental 
anguish.  This  is  a  very  simple  remedy,  with  no 
danger    to    the    patient.      Resorcin    controls    the 


diarrhea  by  inhibiting  fermentation  of  the  intes- 
tinal contents. 

Realizing  that  others  are  as  ignorant  as  I.  this 
paper  was  written  with  the  view  of  aiding  them 
in  a  like  predicament  with  me. 


INFANTILE     lALNDICK. 


By  Nathan  Winslow,  M.D. 

In  the  newly-born  two  varieties  of  jaundice  are 
encountered:    (1)    Physiological;   (2)    Septic. 

Physiological. — According  to  statistics,  jaundice 
makes  its  appearance  in  33  per  cent,  of  all  recently- 
delivered  children  about  the  fourth  or  fifth  day  of 
their  life.  After  increasing  in  severity  for  a  day 
or  two,  it  slowly  disappears.  The  duration  of  the 
average  case  is  three  or  four  days,  but  at  times  it 
lasts  a  week.  It  shows  no  preference  for  either 
sex,  one  being  attacked  as  frequently  as  the  other. 
It  occurs  more  often  in  the  cases  of  premature 
birth.  The  discoloration  is  first  noticed  in  the 
skin  of  the  face  and  chest,  then  in  the  conjunctiva, 
and  finally  in  the  legs  and  arms.  The  color  of  the 
skin  varies  from  a  pale  to  a  dark  yellow.  Idio- 
pathic jaundice  is  not  associated  with  any  rise  of 
temperature.  The  intestines  are  not  affected  in 
this  form  of  infantile  jaundice.  We  rarely  see 
any  difference  in  the  color  of  the  stools.  The 
urine  is  very  apt  to  be  normal,  but  at  times  it  may 
contain  bile. 

Its  pathology  is  unknown,  but  some  believe  it 
to  be  hepatogenous  in  its  origin  and  due  to  a 
resorption.  In  consequence  of  the  great  changes 
taking  place  in  the  circulation  of  the  liver  as  well 
as  in  the  circulatory  fluid  itself,  there  is  an  en- 
gorgement of  the  portal  circulation  which  presses 
upon  the  biliary  capillaries  and  causes  a  stasis  of 
the  bile.  Owing  to  this  congestion  of  the  portal 
circulation,  the  great  destruction  of  the  red  cor- 
puscles taking  place  in  the  liver  and  the  stasis  in 
the  biliary  ducts,  there  is  an  absorption  of  bile  by 
the  blood  vessels.  This  malady  is  never  fatal, 
and  requires  no  treatment. 

Malignant  Jaundice. — Occasionally  jaundice  is 
met  as  a  symptom  of  an  infection,  for  which  rea- 
son it  is  spoken  of  as  septic  or  malignant  jaundice. 
This  condition  arises  in  the  greatest  number  of 
cases  from  infections  taking  place  through  the 
umbilicus  ;  in  fact,  80  per  cent,  of  the  infections 
of  the  newly-born  occur  through  the  above-named 
source,  but  wounds  or  abrasions  of  the  skin  or 


172 


THE    HOSPITAL    BULLETIN 


mucous  membrane,  such  as  those  caused  by  the 
application  of  forceps,  offer  also  portals  of  en- 
trance to  pathogenic  bacteria. 

In  cases  where  the  umbilicus  is  the  seat  of  the 
lesion,  the  symptoms  depend  upon  the  variety  and 
virulence  of  the  organism  and  the  physical  con- 
dition of  the  victim.  If  the  invading  germ  be- 
longs to  the  staphylococcus  group,  an  omphalitis 
is  present,  and  if  the  organism  is  virulent  enough, 
local  abscesses  may  make  their  appearance  about 
the  seventh  or  tenth  day  in  the  abdominal  wall. 
If  the  exciting  cause  is  the  streptococcus,  the  in- 
fection is  much  more  extensive,  and  in  those  cases 
in  which  the  resisting  power  of  the  child  is  low- 
ered or  the  germs  are  extraordinary  virulent,  the 
peritoneum  is  apt  to  be  involved,  whence  the  or- 
ganisms gain  an  entrance  into  the  general  circu- 
lation, giving  rise  to  a  septicemia.  The  etiological 
factors  of  septic  jaundice  are  identically  the  same 
organisms  as  those  found  in  adult  septicemia. 
The  jaundice  associated  with  septic  infection 
hasn't  such  an  intense  hue,  but  is  more  persistent 
than  that  found  in  idiopathic  jaundice.  As  septic 
jaundice  is  only  a  symptom  of  blood  poisoning,  we 
will  also  have  all  the  other  signs  of  septics,  such  as 
a  weak,  rapid,  corded  pulse ;  increased,  shallow 
respirations ;  pinched  features ;  sunken  eyes ;  ab- 
dominal distension,  tenderness  and  tympany  ;  re- 
versed peristalsis  of  the  bowels  and  fecal  vomit- 
ing ;  septic  temperature.  The  toxines  first  stimu- 
late the  nervous  system,  so  that  the  patient  is  ex- 
ceedingly irritable  and  restless.  As  the  poison 
increases,  however,  very  rapidly,  delirium  soon 
gives  place  to  convulsions,  stupor  or  coma.  In 
these  cases  we  obtain  histories  of  the  umbilical 
wound  having  been  handled  with  no  aseptic  pre- 
cautions. 

Winkel's  Disease. — Sometimes  jaundice  appears 
in  epidemic  form,  when  it  is  known  as  Winkel's 
disease.  The  essential  features  of  the  disease  are 
hemoglobinuria,  with  intense  icterus  of  the  skin 
and  internal  organs.  It  is  a  very  rare  and  fatal 
malady,  occurring  mainly  in  institutions.  It  is 
undoubtedly  due  to  some  infection,  and  is  sup- 
posed to  be  caused  by  a  peculiar  form  of  strepto- 
coccus. The  symptoms  usually  begin  from  the 
fifth  to  the  eighth  day  after  birth.  They  are  in- 
tense and  fulminating  in  character,  seldom  last- 
ing more  than  a  day  or  two.  The  urine  is  passed 
frequently,  in  small  quantities,  and  with  strangury. 
It  is  of  a  brown,  smoky  color,  and  under  the  mi- 
croscope shows  the  presence  of  hemoglobin  and 


red  blood  cells,  but  it  does  not  contain  bile.  The 
jaundice  of  the  skin  is  intense,  and  the  patient 
has  a  brownish  hue.  All  of  the  cardinal  symptoms 
of  sepsis,  such  as  a  weak,  rapid  pulse,  shallow, 
hurried  respirations,  prostration,  delirium,  stupor 
and  coma,  will  be  present. 

When  due  to  the  staphylococcus,  the  prognosis 
is  good,  but  in  all  other  instances  the  case  is  very 
likely  to  end  fatally. 

The  treatment  is  largely  prophylactic.  You 
should  treat  the  umbilicus  as  asepticallv  as  vou 
would  any  other  wound.  In  symptomatic  iaun- 
dice  treatment  is  of  little  avail,  but  alcoholic  and 
ammoniacal  remedies  may  be  tried.  If  abscesses 
are  present,  open  them.  Keep  the  child  alive  with 
stimulants,  and  apply  hot-water  bags  to  the  ex- 
tremities. In  desperate  cases  normal  salt  infusions 
mav  be  tried. 


THE  PART  THE  UNIVERSITY   PLAYED 
IN   OPHTHALMOLOGICAL  DE- 
VELOPMENT  IN 
AMERICA. 

The  foundation  of  the  Baltimore  Infirmary 
was  laid  in  1823,  and  patients  were  received  the 
same  year.  There  were  four  wards,  of  which  one 
was  reserved  for  eye  diseases,  instruction  in  oph- 
thalmic surgery  forming  a  prominent  feature  in 
the  course  (Hubbell,  The  Development  of  Oph- 
thalmology in  America).  Be  this  as  it  may,  we 
can  find  no  authentic  record  as  to  who  gave  the 
course  of  instruction.  He  attributes  it  to  George 
Frick,  M.D.,  a  prominent  ophthalmologist  of  the 
day,  and  later  professor  of  natural  history.  Uni- 
versity of  Maryland. 

According  to  the  same  authority,  George  Frick 
was  the  first  in  America  to  undertake  to  restrict 
his  professional  work  almost  exclusively  to  oph- 
thalmology. He  was  born  in  Baltimore  in  1703. 
After  completing  his  medical  studies  and  grad- 
uating from  the  University  of  Pennsylvania  in 
181 5,  he  was  licensed  to  practice  in  his  native 
city  in  1817.  He  visited  Europe,  where  he  be- 
came a  favorite  pupil  of  the  celebrated  Vienna 
ophthalmologist,  Beer.  He  came  to  feel  deeply 
the  dearth  of  knowledge  of  diseases  of  the  eye  in 
America,  and  set  himself  to  work  to  so  qualify 
himself  under  the  great  master  that  he  might 
return  to  his  home  and  give  some  enlightenment 
and  a  scientific  uplift  to  a  neglected  department 
of  medicine.     After  a  prolonged  period  of  study 


THE    HOSPITAL    BULLETIN 


l/3 


and  enthused  by  Beer  as  an  exclusive  specialist, 
he  returned  to  Baltimore  in  1818  and  undertook 
in  a  measure  to  follow  his  teacher's  example.  He 
at  once  began  his  plans  for  ophthalmologic  work. 
He  organized  a  special  eye  clinic  in  connection 
with  the  Baltimore  Dispensary  and  established 
a  course  of  lectures  in  the  University  of  Mary- 
land. Having  tastes  for  other  pursuits,  he  was 
led  to  abandon  his  profession  so  well  begun.  He 
finally  repaired  to  Dresden,  where  he  died  in 
1870,  at  "j"  years  of  age. 

Additional  notes  upon  this  subject  will  appear 
from  time  to  time  in  the  BULLETIN. 


PERSONAL  NOTICE. 

Dr.  Allen  Keer  Bond,  class  of  1885,  of  Balti- 
more, Md.,  formerly  librarian  of  the  Medical  and 
Chirurgical  Faculty  of  Maryland,  editor  of  the 
Maryland  Medical  Journal  and  lecturer  on  dis- 
eases of  children  and  dermatology  in  the  Balti- 
more Medical  College,  was  born  March  irt,  1859, 
at  Kalmia,  Harford  County,  Maryland,  on  lands 
which  were  deeded  to  his  ancestors  by  Lord  Balti- 
more in  the  early  time  of  the  colony.  He  is  of 
American  and  Scotch  ancestry,  and  comes  of  a 
family  of  physicians,  of  some  of  whom  a  brief 
mention  is  opportune. 

His  great-grandfather.  Dr.  Solomon  Birckhead, 
was  an  eminent  and  highly-esteemed  physician,  the 
period  of  whose  active  life  included  parts  of  two 
centuries.  He  was  born  at  Cambridge,  Md.,  July 
21,  1 76 1  ;  graduated  in  medicine  from  the  Univer- 
sity of  Pennsylvania  in  1783  ;  was  treasurer  of  the 
Medical  and  Chirurgical  Faculty  of  Maryland 
from  1809  to  181 1  ;  consulting  physician  to  Balti- 
more Hospital  in  1812,  and  died  in  Baltimore 
November  30,  1836. 

Dr.  Thomas  Emerson  Bond,  grandfather  of  Dr. 
Allen  Kerr  Bond,  was  born  in  the  city  of  Balti- 
more in  February,  1782,  and  was  one  of  the  most 
distinguished  physicians  of  his  time.  He  grad- 
uated in  medicine  at  the  University  of  Pennsyl- 
vania in  18 19,  and  also  received  the  degree  of 
D.D.  He  practiced  in  Baltimore  many  years, 
and  was  president  of  the  Medical  and  Chirurgical 
Society  of  Baltimore,  1832-33;  member  of  the 
City  Council  in  1837;  president  of  the  City  Board 
of  Health  in  1839 ;  president  of  the  board  of  Trus- 
tees of  Baltimore  College  of  Dental  Surgery,  1839. 
He  also  was  a  local  preacher  of  the  Methodist 
Episcopal  Church,  and  his  zeal  and  abilitv  pro- 
cured him  the  title  of  "Defender  of  the  Church." 


He  was  editor  of  the  Itinerant,  1830-31,  and  of  the 
Christian  Advocate  and  Journal  of  New  York  for 
12  years,  1840-52.  Dr.  Bond  died  in  New  York 
city  March  14,  1856. 

Dr.  Thomas  Emerson  Bond,  Jr.,  son  of  the 
above  mentioned  and  father  of  Dr.  Allen  Kerr 
Bond,  was  born  in  Harford  County,  Maryland, 
in  November,  1813,  and  received  the  M.A.  degree 
from  Baltimore  College  in  1830  and  the  degree  of 
M.D.  from  the  University  of  Maryland  in  1824. 
He  practiced  in  Baltimore  about  15  years,  and  in 
1853  returned  to  his  native  county,  and  after- 
wards devoted  his  attention  to  literarv  and  church 
work,  for  he,  too,  was  a  local  preacher  of  the 
Methodist  Episcopal  Church.  In  1839  he  helped 
to  found  the  Baltimore  College  of  Dental  Surgery, 
and  was  its  professor  of  special  pathology  and 
therapeutics  from  1839  to  1872,  and  dean  of  the 
college  from  1842  to  1849.  He  was  a  member 
of  the  City  Council  in  1847;  professor  of  materia 
medica  and  hygiene  in  Washington  University, 
Baltimore,  from  1842  to  185 1,  and  in  1867  took  a 
prominent  part  in  the  work  of  reorganizing  the 
University. 

As  an  author  and  editor  Dr.  Bond  enjoyed  a 
wide  reputation.  His  first  published  "work  was 
"Treatise  on  First  Dentition"  (from  the  French 
of  M.  Baumes),  New  York,  184 1,  which  was  fol- 
lowed by  his  "Treatise  on  Dental  Medicine,"  8  v., 
Philadelphia,  1851-52.  He  was  also  author  of 
"The  Life  of  John  Knox" ;  joint  editor  of  The 
Guardian  of  Health,  1841  ;  editor  of  The  Balti- 
more Christian  Advocate  and  the  Episcopal  Meth- 
odist.   Dr.  Bond  died  August  19,  1872. 

Dr.  Allen  Kerr  Bond  acquired  his  earlier  liter- 
ary education  in  Belair  Academy,  Curtis  Academy, 
at  Fallston.  Md.,  and  George  C.  Carey's  private 
school,  in  Baltimore,  and  his  higher  education  at 
the  Johns  Hopkins  University,  where  he  grad- 
uated with  the  degree  of  B.A.,  in  1880.  He  was 
educated  for  the  profession  of  Medicine  at  the 
University  of  Maryland  School  of  Medicine, 
graduating  from  that  institution  as  Tiffany  prize- 
man, with  the  degree  of  M.D.,  in  1882.  In  1882- 
83  he  was  a  resident  physician  to  Bayview  Hos- 
pital. In  1885-86  he  took  special  courses  in  the 
Imperial  Hospital  at  Yienna.  Austria.  He  has, 
since  graduating,  engaged  in  the  practice  of  his 
profession  as  his  forbears  in  Baltimore,  and  in 
connection  therewith  has  given  of  his  time  to 
hospital  and  editorial  work,  and  also  to  profes- 
sional attendance  at  various  eleemosvnarv  insti- 


174 


THE    HOSPITAL    BULLETIN 


tutions.  In  1884  he  was  librarian  of  the  Medical 
and  Chirurgical  Faculty  of  Maryland,  and  for  five 
years  lecturer  on  diseases  of  children  and  der- 
matology in  the  Baltimore  Medical  College.  For 
some  years,  also,  he  was  editor  of  the  Maryland 
Medical  Journal. 

He  became  a  member  of  the  Medical  and 
Chirurgical  Faculty  in  1888.  He  was  a  member 
of  the  Baltimore  Academy  of  Medicine,  the  Mary- 
land Public  Health  Association,  the  Clinical  So- 
ciety of  Baltimore  and  the  Baltimore  Medical 
and  Surgical  Association.  Dr.  Bond  has  pub- 
lished many  clinical  and  philosophical  studies  in 
medicine,  and  also  a  volume  entitled  "How  Can 
I  Cure  My  Indigestion"  { Contempary  Publishing 
Co.,  New  York).  He  married  August  2,  iqp8, 
Louise  Birckhead  Gambrall,  daughter  of  the  late 
Rev.  T.  C.  Gambrall  and  Susan  B.  Gambrall.  Fie 
resides  at  949  Park  avenue,  Baltimore.  Dr.  Bond 
is  a  friend  and  admirer  of  the  University,  and  a 
well-wisher  for  its  success.  I  le  takes  pride  in  its 
advancement  and  evidence  of  renewed  progres- 
siveness. 


URINARY  CALCULUS,  WITH 
(  >PERATION. 


By  R.  R.  Norris,  M.D..  Class  of  1907, 
Crisfield.  Aid.. 

Former  Chief  Resident  Physician   Bayview 
Hospital. 

The  case  I  want  to  bring  to  your  attention  to- 
night is  one  that  came  under  my  observation  at 
Bayview  when  I  was  chief  resident  physician  of 
the  Almshouse  Department.  When  I  first  came 
on  the  staff  the  case  was  pointed  out  to  me  as  a 
case  of  chronic  cystitis  in  an  old  woman  who  was 
irritable  and  hard  to  manage.  She  was  then  being 
irrigated  with  boracic  acid,  but  did  not  show  much 
improvement.  To  be  brief,  10  days  after  I  saw 
her  she  was  removed  from  Bayview  and  taken  to 
her  son's  home  in  Baltimroe  ;  she  remained  there  a 
while,  and  was  then  taken  to  the  Hopkins  Hospi- 
tal, then  to  the  Hebrew  Hospital,  and  after  a 
period  of  about  three  months  she  came  back  to 
Bayview  with  no  improvement.  I  will  now  give 
you  the  historv  of  the  case. 

Mrs.  A.  G. ;  age,  69 ;  nationality.  Hebrew  ;  first 
admittance  to  Bayview,  December  1.  1005;  dis- 
charged. June  20,  1906;  second  admission,  Sep- 
tember 11,  1906. 


Married :  has  had  three  children  ;  no  miscar- 
riages ;  menstrual  historv  was  always  regular ; 
had  metapause  at  45. 

Family  history  :  Negative,  except  father  died  of 
Bright's  disease. 

Past  history  :  Had  all  diseases  of  childhood,  but 
was  always  a  strong  child. 

Present  history :  Has  not  been  well  for  three 
years,  having  suffered  with  a  great  deal  of  pain 
in  the  region  of  the  bladder,  and  complains  of 
dribbling  of  urine  all  the  time ;  has  not  much  ap- 
petite :  feels  too  weak  to  walk,  and  wants  to  stay  in 
bed  all  the  time.  She  also  suffers  at  times  with 
attacks  of  asthma. 

Arteries  hard.  Heart — a  distinct  mitral  mur- 
mur is  present,  and  can  be  heard  very  plainly. 

Lungs — on  ausculation  feeble  visicular  mur- 
murs, associated  with  wheezing  sonorous  rales. 

Percussion — hyporesonance  over  both  lungs. 

Urine — albumin  marked  ;  spg.  low  ;  no  sugar. 

Micropical — great  abundance  of  pus  cell;  epi- 
thelium ;  also  hyline  and  granular  casts. 

( )n  the  last  admission  to  Bayview  I  made  a 
careful  examination,  but  could  find  no  evidence 
of  stone  in  the  bladder,  except  pain  and  objective 
symptoms  given  above. 

1  ordered  her  irrigated,  intending  in  the  mean- 
while to  watch  developments.  After  a  dav  or  two 
the  nurse  reported  that  she  could  not  get  the 
catheter  into  the  urethra.  I  went  down  and  tried 
it  myself,  and  found  the  glass  catheter  struck 
something  metallic  and  hard,  which  turned  out  to 
be  a  large  stone  situated  in  the  lower  part  of  the 
bladder,  filling  up  the  whole  inclosure  of  the 
urethra. 

Owing  to  the  age  and  extremelv  bad  physical 
condition  of  the  patient.  I  hesitated  operating, 
but,  finding  she  could  not  void  now  without  hav- 
ing the  stone  pushed  back  with  a  catheter  to  let 
the  urine  escape,  and  that  this  gave  her  much 
pain,  I  finally  decided  to  operate,  and  after  a  lot 
of  persuasion  secured  her  consent  to  be  operated 
upon. 

The  operation  was  set  for  two  days  from  this 
date,  but  in  the  meanwhile  she  was  taken  with  a 
bad  attack  of  asthma,  which  came  near  causing 
her  death. 

However,  this  cleared  up  fairly  well,  and  in  a 
week  I  had  her  prepared  for  operation,  having 
first  previously  ordered  her  to  have  plenty  of 
water,  a  tonic  T.  I.  D.  and  urotropin.  grains  5, 
morning  and  evening. 


THE    HOSPITAL    BULLETIN 


i"5 


(  >n  September  28,  1906,  at  10  A.  M.,  she  was 
brought  in  the  operating-room  prepared  for  op- 
eration. I  desired  to  enter  the  bladder  through 
the  vagina,  as  I  had  to  be  quick  and  could  give 
but  very  little  ether,  owing  to  the  bad  physical 
condition. 

I  washed  the  vagina  out  well,  and,  having  an 
assistant  hold  the  vagina  open  with  retractors, 
I  passed  a  grooved  steel  male  catheter  through 
the  urethra,  the  blade  going  downward.  Using 
the  catheter  as  a  guide,  I  made  a  small  incision 
about  an  inch  below  the  urethra,  cutting  through 
the  mucous  membrane  of  the  vagina  into  the  blad- 
der. I  next  passed  a  pair  of  bullet  forceps  in. 
grabbed  the  stone  and  removed  it  intact,  as  you 
see  by  the  specimen. 

I  then  washed  the  bladder  thoroughly  with  a 
hot  boracic  solution,  and  after  getting  out  as  much 
pus  as  possible,  I  closed  the  wound  with  three 
fine  black  silk  sutures,  rather  close  together.  Then 
taking  two  small  rubber  catheters  which  had  been 
previously  tied  together  and  boiled,  I  passed  them 
down  the  urethra  into  the  bladder. 

Patient  was  removed  to  bed.  I  attached  one  of 
the  catheters  just  mentioned  to  an  irrigating  jar, 
letting  a  hot  boracic  solution  pass  into  the  blad- 
der through  one  catheter  and  out  into  a  pail 
through  the  other.  I  kept  this  irrigation  up  about 
36  hours,  then  examined  the  wound,  and  found  it 
almost  healed.  At  the  end  of  five  days  I  took 
out  the  sutures,  and  the  wound  was  about  closed. 
I  got  the  patient  out  of  bed  into  an  easy  chair. 
She  voided  involuntarily  for  about  a  week,  but 
at  the  end  of  this  time  she  suffered  no  pain  or  in- 
convenience, and  in  two  weeks  the  wound  closed 
entirely,  and  she  was  able  to  retain  and  pass  her 
urine  at  her  will.  Owing  to  her  age  and  general 
debility,  she  could  not  get  around  very  well,  but 
when  I  left  Bayview,  1 1  months  after,  she  was  in 
good  shape  as  far  as  the  bladder  trouble  was  con- 
cerned. 

April  5,  1909. 


ACADEMIC  DAY  AT  THE  UNIVERSITY 
OF   MARYLAND. 


The  University  of  Maryland's  academic  day  ex- 
ercises, commemorating  the  one  hundred  and 
twentieth  anniversary  of  St.  John's  College,  which 
was  affiliated  with  the  university  two  years  ago, 
were  held  at  Westminster  Presbvterian  Church, 


Favette  and  Greene  streets,  Thursday  morning. 
November  1 1. 

A  memorial  address  in  honor  of  John  Prestiss 
Poe,  late  secretary  of  the  regents,  dean  of  the 
faculty  of  law,  and  for  40  years  a  professor  of  law 
in  the  university,  by  Judge  Henry  D.  Harlan, 
marked  the  exercises.  The  degree  of  doctor  of 
laws  was  conferred  upon  State  Comptroller 
Joshua  \Y.  Heriug  and  Dr.  Charles  Horace  Mayo 
of  Minnesota. 

At  10.30  o'clock  the  faculty  and  students  of  the 
university  assembled  and  marched  to  the  church. 
The  line  was  formed  of  students  from  the  depart- 
ment of  arts  and  sciences  of  St.  John's  College, 
the  departments  of  medicine  and  pharmacy,  the 
chancellor,  the  provost  and  regents  of  the  univer- 
sity, the  faculties  and  adjutant  faculties,  orators 
and  guests  and  the  alumni. 

The  exercises  were  opened  with  an  invocation 
by  Rev.  Thomas  Grier  Koontz,  pastor  of  the 
church. 

In  the  absence  of  the  provost,  Mr.  Bernard 
Carter,  the  greeting  was  made  by  Judge  Henry 
Stockbridge.  He  declared  that  the  occasion  was 
one  which  brought  the  several  departments  of  the 
university  into  closer  touch  and  served  as  a  me- 
dium for  the  interchange  of  greetings  between  the 
university  and  other  institutions  of  the  country. 

"It  enables  the  university,"  he  said,  "to  express 
its  good-will  and  aims  to  its  students  and  their 
friends  and  all  others  interested  in  elevating  the 
standard  of  professional  and  technical  training." 

Announcements  of  chairs  to  be  filled  to  take 
Mr.  Poe's  place  were  made  by  Judge  Stockbridge. 
Judge  Harlan  was  elected  to  succeed  Mr.  Poe  as 
dean  of  the  law  department,  and  Mr.  William  L. 
Marbury  of  the  class  of  1882  to  lecture  on  the 
subject  of  torts  during  the  second  half  of  the 
year.  Judge  James  B.  Gorter  will  become  lec- 
turer on  evidence,  and  Mr.  Joseph  C.  France  on 
pleading  and  practice. 

This  distributes  among  three  the  courses  pre- 
viously directed  by  Mr.  Poe.  In  accepting  the 
position  as  lecturer  on  pleading  and  practice,  Mr. 
France  retires  as  lecturer  on  elementary  law  and 
jurisprudence.  No  selection  has  yet  been  made 
to  fill  the  vacancy. 

Messrs.  Hobart  Smock  and  B.  Merrill  Hopkin- 
son  sang  "Guide,  O  Thou  Great  Jehovah."  The 
balance  of  the  musical  program  was  under  the  di- 
rection of  Dr.  Hopkinson. 


1 76 


THE    HOSPITAL    BULLETIN 


Judge  Harlan  eulogized  Mr.  Poe,  saying,  in 
part : 

"It  has  been  deemed  appropriate  that  this  first 
meeting  since  the  death  of  the  late  dean  of  the 
law  school,  when  are  assembled  the  faculties  and 
the  students,  many  alumni  and  friends  of  this 
university,  should  not  pass  without  some  account 
of  the  life  and  tribute  to  the  memory  of  one 
whose  work  has  been  so  conspicious  ;  whose  claims 
to  the  love  and  honor  of  all  connected  with  it  are 
so  strong,  and  whose  presence  is  missed  today. 

"The  duty  of  paying  this  tribute  has  been  in- 
trusted by  the  regents  to  me.  I  regret,  however, 
that  I  am  not  better  qualified  to  discharge  it  ac- 
cording to  its  deserts.  In  view,  however,  of  the 
fact  that  for  30  or  40  years,  through  which  his 
labors  were  extended,  I  have  been  a  daily  witness 
of  their  performance,  and  for  more  than  25  rears 
— no  inconsiderable  period — have  served  with 
him  in  the  school  of  law,  I  recognize  that  the 
mandate  of  the  regents  is  not  whollv  unjustified, 
and  it  will  afford  me  at  least  the  opportunity  to 
express  my  gratitude  to  and  my  abiding  respect 
and  affection  for  one  who  was  my  legal  preceptor, 
ami  for  all  these  years  my  warm  and  devoted 
friend." 

Judge  Harlan  gave  a  history  of  the  Poe  family, 
and  told  of  Mr.  Poe's  career  as  one  of  the  State's 
ablest  and  most  learned  lawyers.  He  also  told 
of  the  great  interest  Mr.  Poe  had  always  taken 
in  the  work  of  the  university  and  his  impression 
on  the  young  men  with  whom  he  came  in  contact. 
He  concluded  by  relating  the  bravery  of  such  a 
distinguished  man,  and  said  it  only  remained  for 
him  to  read  the  minute  adopted  by  the  regents. 
It  told  of  their  personal  sorrow  and  the  loss  felt 
by  the  university. 

The  principal  address  of  the  day  was  made  by 
Dr.  Archibald  L.  Bouton,  professor  in  the  de- 
partment of  English  literature  at  the  University 
of  New  York.  He  spoke  on  "Is  Culture  Worth 
While?"  and  said  in  part: 

"Every  autumn  many  of  the  colleges  of  New 
England  set  apart  a  dav  called  Mountain  Day, 
when  the  students  lay  aside  their  work  and  ramble 
over  the  neighboring  mountains,  to  appreciate  the 
glorious  outlines  of  the  October  landscape  and  to 
imbibe  something  of  the  serenity  and  strength  of 
the  hills.  Every  October  the  university  with 
which  I  am  concerned,  with  a  somewhat  anal- 
ogous motive,  sets  apart  a  clay  called  Founders' 
Day,  in  which  the  thought  of  our  students  is  di- 


rected backward  over  the  lapse  of  more  than  75 
years,  to  dwell  upon  the  personality  and  ideals 
of  those  who  established  the  university. 

"To  us  in  like  manner  Founders'  Day  brings 
an  opportunity  to  draw  strength  to  ourselves  from 
contemplating  the  foresight,  the  self-sacrifice,  the 
high  idealism  of  the  men  whose  labors  have  made 
the  university  and  our  present  opportunities  pos- 
sible. 

"I  do  not  know  how  long  the  Lmiversity  of 
Maryland  has  observed  the  custom  of  Academic 
Day.  I  know  that  as  a  university  you  look  back- 
ward to  your  founding  for  more  than  a  century 
of  usefulness.  I  know  little  of  the  special  cus- 
toms and  ceremonies  which  have  been  associated 
with  Academic  Day  in  the  past.  I  cannot  be  far 
wrong  in  seeing  in  it  something  of  the  character 
of  an  intellectual  Mountain  Day,  when  we  may 
look  for  a  broader  outlook  and  meditate  on  some 
of  the  special  problems  of  university  life." 

Professor  Bouton  told  of  the  university  life 
and  the  many  advantages  of  the  culture  to  be 
had  there.  He  pointed  out  a  number  of  reasons 
why  students  should  make  something  of  them- 
selves and  why  they  should  aspire  to  know  as 
much  as  their  professors. 

In  conclusion,  he  said  : 

"The  hour  of  our  responsibility  has  come.  In 
my  attempt  to  present  the  conceptions  of  a  real 
culture,  it  seems  to  me  that  in  them  lie  the  broad 
fields  of  a  new  land  of  promise,  toward  which 
America  is  now  ready  to  move  and  to  which  the 
eyes  of  her  people  are  already  lifted." 

PORTRAIT   OF    MR.    TOE  PRESENTED. 

A  portrait  of  Mr.  Poe  by  Dietrich  was  presented 
the  university  by  the  students  of  the  department 
of  law.  The  presentation  speech  was  made  by 
Charles  O.  Laney,  a  student.  It  was  accepted  by 
Judge  Stockbridge,  and  will  be  hung  in  the  uni- 
versity. 

After  the  presentation  honorary  degrees  were 
conferred  on  Drs.  Hering  and  Mayo.  In  bestow- 
ing the  honors  a  short  sketch  of  their  lives  was 
read  by  the  provost.  Afterwards  the  students 
gave  class  yells  and  called  for  speeches.  At  one 
time  the  applause  lasted  five  minutes. 

After  the  exercises,  which  lasted  nearly  two 
hours,  the  faculty  and  guests  had  luncheon  at 
( iermania  Msennerchor  Hall.  The  St.  John's  Col- 
lege cadets  returned  to  Annapolis  on  special  cars 
of  the  Washington,  Baltimore  and  Annapolis 
Electric  Railway. 


THE    HOSPITAL    BULLETIN 


W/ 


THE  HOSPITAL  BULLETIN 

A  Monthly  Journal  of  Medicine  and  Surgery 

EDITED    BY 

A  COMMITTEE  OF  THE  HOSPITAL  STAFF 


PUBLISHED    BY    THE 

HOSPITAL  BULLETIN  COMPANY 
University  of  Maryland 


Business  Address, 
Editorial   Address, 


.     Baltimore,   Md. 
University  of  Maryland 


Baltimore,  Md.,  November  15,   1909 

FOUNDERS'    DAY. 

The  exercises  of  Founders'  Day  at  the  Univer- 
sity of  Maryland,  held  on  November  nth,  were 
of  an  imposing  and  impressive  character.  The 
faculties  and  students  of  all  the  departments  as- 
sembled on  the  grounds  of  the  University  and 
marched  in  a  body  to  old  Westminster  Church, 
S.  E.  corner  Fayette  and  Greene  streets,  where 
the  exercises  were  held. 

In  the  absence  of  the  Hon.  Bernard  Carter, 
provost,  on  account  of  sickness,  Judge  Henry 
Stockbridge  officiated  as  provost,  and  conducted 
the  services  in  a  most  happy  and  successful  man- 
ner. 

The  first  address,  delivered  by  Judge  Plenry 
Harlan,  was  a  memorial  on  the  life  and  services 
of  the  late  Hon.  John  P.  Poe,  for  so  many  years 
Dean  of  the  Law  Department  and  Secretary  of 
the  Board  of  Regents.  Judge  Harlan  paid  a  most 
beautiful  and  graceful  tribute  to  Mr.  Poe  in  an 
address  marked  for  its  scholarship  and  faithful 
presentation  of  the  great  services  Mr.  Poe  had 
rendered  the  State  and  University  of  Maryland. 

The  next  address  was  delivered  by  Dr.  A.  L. 
Bouton  of  the  University  of  New  York  on  the 
subject,  "Is  Culture  Worth  While?" 

Dr.  Bouton  handled  his  subject  in  a  most  schol- 
arly and  exhaustive  manner,  and  succeeded  in  con- 
vincing the  audience  that  culture  is  worth  while. 

The  honorary  degree  of  LL.D.  was  next  con- 
ferred by  Judge  Stockbridge  on  behalf  of  the 
Regents  of  the  University  of  Maryland  on  the 
Hon.  Joshua  L.  Hering  of  the  class  of  1855,  now 
Comptroller  of  the  State  of  Maryland  and  Presi- 
dent of  the  Board  of  Trustees  of  Western  Mary- 


land College,  and  upon  Dr.  Charles  H.  Mayo  of 
Rochester,  Minn.,  the  distinguished  surgeon,  who, 
on  the  9th  and  10th  of  November,  had  delivered 
lectures  on  the  "Surgery  of  the  Thyroid"  before 
the  students  of  the  University  and  invited  guests 
of  the  Faculty  of  Physics  in  Chemical  Hall. 

The  exercises  were  interspersed  with  vocal 
music  under  the  direction  of  Dr.  B.  Merrill  Hop- 
kinson,  an  alumnus  of  the  University.  It  is  es- 
timated that  there  were  over  800  students  of  the 
various  departments  present,  in  addition  to  their 
friends  and  members  of  the  different  teaching 
bodies. 

This  the  second  celebration  of  Founders'  Day 
at  the  University  of  Maryland  was  a  most  success- 
ful occasion,  and  marks  the  permanent  observance 
of  this  academic  function  in  the  future  work  of 
the  University. 

In  other  words.  Founders'  Day  has  come  to 
stay,  and  from  year  to  year  as  time  rolls  on  the 
exercises  of  this  day  may  be  regarded  as  mile- 
stones to  mark  the  progress  of  the  University  in 
the  great  work  she  is  destined  to  do  in  the  world 
of  education  for  the  people  of  Maryland  and  for 
her  growing  student  bodies  filled  with  recruits 
from  all  parts  of  our  land  and  foreign  lands. 

This  day,  so  auspiciously  inaugurated  last  year, 
has  done  more  to  strengthen  the  bonds  of  union 
between  the  departments  of  the  University  and 
to  build  up  a  university  life  and  spirit  than  all  the 
agencies  hitherto  employed.  Each  year  these 
bonds  will  strengthen,  and  at  no  far  distant  day 
the  friends  of  the  University  will  find  an  organi- 
zation and  administration  which  will  conduct  the 
affairs  of  the  University  along  broader  and  more 
progressive  lines.  As  sure  as  the  world  runs 
its  daily  course,  just  so  sure  will  these  improve- 
ments and  reforms  come  in  the  work  of  the  old 
University.  Her  friends  are  growing,  the  public 
interest  in  her  affairs  is  increasing  and  her  present 
governing  body  is  moving  with  caution,  but  with 
resolute  purpose,  in  the  right  direction.  Her  con- 
tinued growth,  usefulness  and  prosperity  are  as- 
sured. 


THE  CARROLL  FUND. 

Merit  has  her  reward.  The  committee  in  charge 
of  the  Carroll  Fund  request  no  further  contribu- 
tions be  made,  as  sufficient  money  for  the  purpose 
in  hand.  Alumni  of  the  University  of  Maryland 
should  feel  a  pang  of  pride  that  the  medical  pro- 


THE    HOSPITAL    BULLETIN 


fession  of  the  United  States  at  large  has  adjudged 
the  labors  of  a  brother  alumnus  of  so  marked  dis- 
tinction as  to  merit  their  contributions  to  help 
raise  a  mortgage  on  the  home  of  his  widow.  The 
Journal  of  the  American  Medical  Association  edi- 
torially voices  these  sentiments  on  the  completion 
of  the  fund: 

"It  will  gratify  all  to  learn  of  the  completion  of 
the  fund  for  a  home  for  the  wife  of  Major  Carroll 
of  yellow-fever  fame.  Major  Ireland,  of  the  medi- 
cal corps  of  the  Army,  who  so  kindly  assumer 
charge  of  the  receiving  of  remittances,  announces 
that  the  contributions  now  in  his  hands  are  suffi- 
cient to  pay  off  the  entire  indebtedness  on  the 
property  and  leave  a  small  balance.  Further  con- 
tributions for  this  fund  are,  therefore,  unnecessary. 
The  committee  is  to  be  congratulated  on  the  able 
and  rapid  manner  in  which  it  lias  raised  this 
amount,  and  the  profession  at  large,  and  others, 
are  to  be  thanked  for  the  manner  in  which  they 
generously  and  promptly  responded  to  the  appeal 
for  contributions.  The  success  of  this  undertak- 
ing is  an  evidence  of  the  honor  and  esteem  in  which 
Dr.  Carroll's  memory  is  held  for  his  self-sacrifice 
which  led  indirectly  to  his  fatal  affliction.  In  suf- 
fering himself  to  be  bitten  by  yellow-fever  mos- 
quitoes as  one  of  the  necessary  steps  in  solving  the 
problem  of  that  disease,  Dr.  Carroll  merely  fol- 
lowed what  seemed  to  him  to  be  in  the  line  of 
duty.  But  history  inscribes  his  name  among  the 
heroes  and  martyrs,  and  enrolls  among  his  debtors 
not  only  his  profession  and  science,  but  also  com- 
merce, his  nation  and  the  whole  world." 


ABSTRACTS. 
Benigx  Tumors  of  the  Turbinated  Bodies 
Clinically  and  PATHOLOGICALLY- 
CONSIDERED. 

According  to  Richard  H.  Johnston,  class  of 
1894,  Journal  of  AM.  A.,  July  24,  1909.  Exclud- 
ing nasay  polypi,  benign  tumors  of  the  turbinated 
bodies  are  very  rare.  Less  than  twenty  true  papil- 
lomata  of  the  nasal  cavities  have  been  recorded  in 
rhinologic  literature.  In  a  special  practice  of 
eight  years  he  has  only  seen  clinically  three  benign 
tumors  of  the  turbinated  bodies,  and  has  examined 
pathologically  three  other  benign  growths  referred 
to  him  by  other  rhinologists.  Of  the  six  patients 
four  were  female  and  two  males,  their  ages  ranged 
from  1?  to  60  years.  In  sum  arizing  he  calls 
especial  attention  to  the  possibility  of  the  trans- 
formation of  benign  into  malignant  growths. 


Mr.  and  Mrs.  II.  M.  Turner,  of  Shepherdstown, 
West  Virginia,  have  announced  the  engagement  of 
their  daughter,  Miss  Loraine  Turner,  to  Doctor 
Nathaniel  Burwell,  class  of  1907.  Doctor  Bur- 
well  is  a  native  of  Clarke  county,  Virginia,  and 
is  a  practicing  physician  of  Shepherdstown.  The 
wedding  will  take  place  in  October. 

"The  Recorder,"  the  official  organ  of  the  "Su- 
preme Ruling  of  the  Fraternal  Mystic  Circle,"  of 
August  made  the  following  eulogistic  remarks 
about  Doctor  Arthur  E.  Ewens,  class  of  1904, 
of  Atlantic  City,  New  Jersey: 


THE  LATE  HON.  JOHN  P.  POE'S  CONNEC- 
TION WITH  THE  UNIVERSITV 
OF  MARYLAND. 


Seldom  in  the  life  of  a  teacher,  and  especially  in 
the  case  of  a  professional  man  in  the  pursuit  of  law 
or  medicine,  does  it  happen  that  a  preceptor  retains 
the  same  chair  in  an  institution  for  a  term  ap- 
proaching twoscore  years,  but  this  honor  belongs 
to  Mr.  Poe,  who  this  fall  began  his  fortieth  year 
as  professor  of  pleading  and  practice  in  the  Mary- 
land University  Law  School. 

In  October  of  1870  Mr.  Poe  began  his  lectures 
on  "Pleading  and  Practice,"  and  in  1872  the  addi- 
tional course  of  "The  Law  of  Evidence"  was 
added  to  his  work  in  the  law  school.  A  third,sub- 
ject,  "Legal  Ethics,"  was  assigned  to  him  last  year 
on  account  of  the  retirement  of  Prof.  John  J.  Don- 
aldson from  the  chair  of  jurisprudence  and  ethics. 

In  opening  his  course  of  lectures  at  the  univer- 
sity several  weeks  ago  Mr.  Poe  called  attention  to 
his  long  term  of  service  and  said  : 

"Thirty-nine  years  is  a  long  time,  and  in  that 
span  I  have  seen  many  students  come  and  go.  I 
also  call  to  mind  some  of  the  most  distinguished 
professors  of  this  school,  and  some  of  the  most 
conspicuous  and  eminent  of  our  judges  with 
whom  I  have  been  closely  acquainted.  I  merely 
call  this  to  your  mind  as  an  encouragement  and 
inspiration  to  follow  in  the  steps  of  your  distin- 
guished alumni,  and  in  the  years  to  come  to  add 
fresh  glory  and  renown  upon  your  alma  mater." 

"In  the  autumn  of  1869  I  was  notified  that  the 
vacancies  then  existing  in  the  board  of  regents  of 
the  School  of  Law  of  the  LTiiversitv  of  Marvland 


THE    HOSPITAL    BULLETIN 


179 


had  been  filled  by  the  election  of  Hon.  George  Wil- 
liam Drown  (afterward  Chief  Judge  Brown). 
Messrs.  Bernard  Carter.  Henry  Clay  Dallam  and 
myself. 

"We  accepted  the  positions  which  we  were  then 
called  to  fill  in  the  law  department  of  the  univer- 
sity. The  exercises,  which  had  been  suspended 
for  a  number  of  years,  were  resumed.  The  de- 
partment was  reorganized  by  the  election  of  the 
late  Judge  John  A.  Inglis  as  the  professor  of  law 
and  as  such  a  member  of  the  board  of  regents,  and 
the  late  Judge  Robert  X.  Martin  as  a  professor. 

"Lectures  in  the  Law  School  were  begun  in 
February.  1870.  and  were  regularly  delivered  to 
a  very  small  class  by  Judges  Inglis  and  Martin 
until  the  summer  recess  of  that  year.  In  the  sum- 
mer of  1870  Judge  Robert  X.  Martin  died  sud- 
denly, and  the  vacancy  was  filled  by  the  election 
of  Judge  Alexander  H.  Handy,  formerly  Chief 
Justice  of  the  Court  of  Errors  and  Appeals  of 
Mississippi. 

"I  was  called  to  the  chair  of  pleading  and  prac- 
tice in  courts  of  law,  and  began  my  lectures  in 
October,  1S70.  My  class  during  that  university 
year  numbered  sometimes  three  and  occasionally 
as  many  as  seven.  My  lectures  were  all  delivered 
at  night. 

"In  1872  the  additional  subject,  the  'Law  of  Evi- 
dence," was  assigned  to  me.  I  have  been  continu- 
ally engaged  in  the  work  of  instruction  in  this  law 
school  since  1870. 

"Prof.  Samuel  C.  Chew  of  the  faculty  of  physic 
and  I  are  the  only  survivors  of  the  board  of 
regents  at  the  time  of  ray  election. 

"The  late  Severn  Teackle  Wallis  was  unani- 
mously elected  in  1870  as  provost  of  the  university 
to  take  the  place  of  Hon.  John  P.  Kennedy,  who 
had  filled  that  office  from  1850  until  his  death.  Mr. 
Wallis  held  the  office  of  provost  until  his  death  in 
April,  1894,  and  in  June,  1894,  Mr.  Bernard  Car- 
ter was  elected  provost,  which  office  he  still  holds." 


ITEMS 

Dr.  Ejnar  Hansen,  41  E.  41st  street,  Xew  York, 
writes  to  the  Bulletin  : 

"Inclosed  a  check  for  subscription.  Could  I 
from  you  get  a  iist  of  the  physicians — graduates 
from  our  old  school — now  practicing  in  Xew  York 
city?  I  should  like  to  find  them,  and,  if  possible, 
start  a  little  University  of  Maryland  Society  here 
in  Xew  York  city.     The  Blt.letix  is  a  welcome 


guest  in  my  home  every  month,  and  I  read  it  from 
beginning  to  end,  trying  in  that  way  to  keep  in 
touch  with  the  school  hospital  and  old  friends. 
Success  to  vou." 


Dr.  Piatt  W.  Covington,  class  of  iqo8,  after  one 
year  of  service  as  pathological  to  the  Maryland 
Hospital  for  the  Insane  has  returned  to  his  home 
in  Rockingham,  X.  C,  for  private  practice. 


Dr.  Summerfield  B.  Bond,  chief  medical  exam- 
iner of  the  Baltimore  &•  <  )hio  Railroad,  attended 
a  joint  meeting  of  the  chief  examiners  of  a  num- 
ber of  the  more  important  railroads  of  the  United 
States.  The  meeting  was  for  the  purpose  of  the 
interchange  of  experience  and  in  a  general  way 
to  promote  the  work  of  the  medical  and  surgical 
corps  under  their  direction.  The  meeting  was 
held  in  the  B.  &  (  >.  Building',  Baltimore. 


The  senior  class  of  the  Medical  Department  of 
the  University  of  Maryland  has  elected  the  fol- 
lowing officers  for  the  ensuing  year:  President, 
Frank  P.  Fiery,  Maryland;  Yice- President,  R.  R. 
Diller,  Maryland;  Secretary,  C.  X.  Devilbiss, 
Maryland:  Treasurer,  E.  H.  Kloman,  Virginia; 
Historian,  A.  L.  Little,  Xorth  Carolina  ;  Sergeant- 
at-Arms.  M.  S.  Hanna,  Egypt :  Class  Artist,  G. 
S.  Condit,  West  Virginia.  Executive  Committee, 
M.  < 1.  Hoffman,  West  Virginia  1  chairman  )  ;  W. 
A.  ( Iracie,  Maryland ;  M.  E.  P..  Owens,  South 
Carolina;  J.  E.  Talbott,  Maryland;  J.  II.  Yon 
Dreele,  Maryland;  J.  E.  O'Neill,  Maryland:  T. 
Brooks,  Cuba. 


The  annual  reception  to  the  old  and  new  stu- 
dents by  the  Young  Men's  Christian  Association 
of  the  University  of  Maryland  was  given  Mon- 
day evening,  October  11,  1900,  at  8  o'clock,  in  the 
association  room,  Davidge  Hall.  Dr.  S.  C.  Chew 
and  Judge  Henry  D.  Harlan  delivered  addresses, 
and  a  pleasant  musical  program  was  rendered. 
Refreshments  were  served  after  the  exercises. 


Doctors 

J.  Wm.  Funk. 
F.  Caruthers, 
Wm.  S.  Smith. 
1  Carry  Gross, 
A.  D.  McConachie, 
A.  T.  Chambers 
are  visiting  surgeons  to  Franklin  Square  Hospital. 


i  So 


THE    HOSPITAL    BULLETIN 


Drs.  C.  Urban  Smith  and  Win.  II.  Pearce  are  Dr.  and  Mrs.  Cary  B.  Gamble,  Jr.,  of  26  VV. 

visiting  physicians  to  the  Franklin  Square  Hospi-      Biddle  street,  have  returned  from  North  Hatley, 

Canada,  where  they  spent  the  summer. 


tal. 


Dr.  T.  J.  O'Donnell  is  chief  of  clinic  to  the  pro- 
fessor of  operative  surgery,  Franklin  Square 
Hospital. 


Dr.  and  Mrs.  William  Hewson  Baltzell  of  Wel- 
lesley,  Mass.,  are  stoping  at  the  Belvedere,  having 
come  to  Baltimore  for  the  wedding  of  Miss  Agnes 
L.  Selden. 


Dr.  John  S.  Fulton  has  returned  to  Baltimore 
after  spending  the  latter  part  of  the  summer  in 
Europe. 


Dr.  Thomas  C.  Worthington  has  returned  from 
abroad,  where  he  spent  his  summer  vacation. 


Dr.  J.  N.  Reik  has  returned  home  from  Europe, 
where  he  attended  the  International  Medical  Con- 
gress at  Budapest. 


Dr.   Frank   Martin  is  home  after  a  delightful 
summer  spent  on  the  Continent. 


Dr.  Ridgely  B.  Warfield  summered  in  Europe. 


Dr.  B.  Bernard  Browne,  professor  of  gyne- 
cology in  the  Woman's  Medical  College,  Balti- 
more, has  resigned. 


Dr.  J.  Howard  lglehart  has  been  reappointed 
a  medical  inspector  for  the  public  schools  of  Balti- 
more. 


The  junior  class  of  the  University  of  Maryland 
Medical  Department  has  elected  for  the  ensuing 
year  the  following  officers:  President,  Willis 
Lynn,  New  York ;  Vice-President,  William  L. 
Byerly,  Maryland;  Secretary,  B.  S.  Boyer,  Mary- 
land ;  Treasurer,  Louis  H.  Douglas,  Maryland  ; 
Historian,  Henry  D.  Causey,  Delaware  ;  Sergeant- 
at-Arms,  Kenneth  B.  Jones,  Maryland. 


Dr.  and  Mrs.  J.  Whitridge  Williams  have  re- 
turned from  an  extended  stay  abroad,  which  they 
spent  most  of  the  time  in  1  leidelburg,  German}-. 
They  have  reopened  their  residence,  1128  Cathed- 
ral street,  for  the  winter. 


Dr.  William  Dodd  Scott,  Jr.,  class  of  1904,  of 
Baltimore,  has  been  confined  to  the  University 
Hospital  for  the  past  month  with  typhoid  fever. 
We  are  glad  to  report  that  he  is  canvalescing  and 
well  on  the  way  to  recovery.  When  he  gets  out 
he  expects  to  return  to  his  former  home  in  Fred- 
ericksburg, Ya.,  where  he  will  spend  some  time 
recuperating. 


At  the  section  on  Neurology  and  Psychiatry  of 
the  Baltimore  City  Medical  Society,  Friday,  Oc- 
tober 15,  1909,  papers  were  read  by  Dr.  \V.  F. 
Schwartz  on  "Psychasthenia,"  and  Drs.  I.  S. 
Spear  and  R.  P.  Bay  on  "Astereognosis,  with  Re- 
port of  Cases." 


Dr.  Caleb  Noble  Athey,  class  of  1894,  and  Mrs. 
Athey,  have  returned  from  their  honeymoon, 
which  they  spent  in  Europe.  Mrs.  Athey,  nee 
Miss  Helen  Skipwith  Wilmer,  is  a  graduate  of 
the  Johns  Hopkins  Flospital  Training  School  for 
Nurses.  She  met  Dr.  Athey  while  engaged  in 
social  service  work. 


At  the  regular  meeting  of  the  University  of 
Maryland  Medical  Association,  held  in  the 
amphitheatre  of  the  University  Hospital  Tuesday, 
<  Ictober  19,  1909,  at  8.30  P.  M.,  the  program  was 
as  follows : 

Peritonitis,  Etiology — F.  P.  Fiery,  class  of 
1910. 

Symptoms  and  Diagnosis — Dr.  Messick. 

Treatment — Dr.  Shipley. 

This  society  was  created  especially  for  the  pur- 
pose of  bringing  the  faculty  and  student  body 
closer  together,  both  socially  and  instructively. 
At  last  we  seem  to  have  hit  the  keynote  of  success 
by  obtaining  the  interest  and  co-operation  of  the 
students  by  appointing  a  member  from  the  senior 
class  to  present  a  paper  to  the  body.  The  selec- 
tion of  the  subject  for  discussion  is  left  to  a  com- 
mittee of  students,  who,  with  the  president  of  the 
society,  arrange  the  program. 

These  meetings  are  always  very  instructive,  and 
this  especial  one  was  extremely  so.  The  symp- 
toms, etiology  and  treatment  of  peritonitis   was 


THE    HOSPITAL    BULLETIN 


181 


thoroughly  discussed.  There  was  also  an  election 
of  officers  for  the  ensuing  year,  which  resulted  as 
follows:  President,  Dr.  John  T.  O'Mara ;  Vice- 
President,  Dr.  C.  W.  McElfresh ;  Secretary,  Dr. 
Salvatore  Demarco. 


Dr.  Nathaniel  R.  Keirle,  class  of  1858,  superin- 
tendent of  the  Pasteur  Department  of  the  Mercy 
Hospital,  who  celebrated  his  76th  birthday  Sun- 
day, October  10,  1909,  was  given  a  banquet  at 
the  Maryland  Club  Monday  night,  October  n, 
in  recognition  of  his  distinguished  service  to 
science  in  combating  the  ravages  of  rabies.  The 
gathering  included  leaders  in  the  medical